(Golden Oldie) How expectations shape pain

Review written by Dr Sandy Hilton info

Key Points

  1. Placebo affects clinical outcomes in as much as the person believes in the treatment and expects relief.
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Pain is subjective and can occur in the absence of harm (1). Pain is influenced by the meaning to the individual which makes studying cause and effect of a pain response to a stimulus challenging. It is reasonable to assume that all stimuli will have an effect on the cortical structures, as that is fundamental to the function of the structures. It would be worth noting if a stimulus did not result in a cortical response (2).

A challenge for researchers and clinicians is to understand the mechanisms and meanings of pain in order to identify helpful clinical strategies. This review summarized the evidence on expectancy and pain. The authors described the relationship between the beliefs and predictions of outcomes (expectancy) with pain and pain-related cortical responses. They assessed expectancy studies to explore how interventions may be better targeted to help individuals manage pain.

Pain is influenced by the meaning to the individual.
If we show people that they can move without a pain response and teach them that it is safe and beneficial to move, they should have a better outcome.


Studies in 1972 established that conditioned stimuli create expectation about an outcome, and that these expectations cause a response when a motivation exists to avoid or experience that outcome (3,4). The evidence shows that placebo responsiveness is not consistent in

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