The neurobiology of placebo

The placebo effect is one of the many wonders in nature. The phenomenon rests on induced expectation. This means that it requires an internalized model of the future that may act as a template. There has been an evolutionary drive for a development of predictive capacity and one result is the development of the frontal lobes. This development of the frontal lobes has gradually developed the representational space of the self in time and space. The model of the future can be influenced by explicit and implicit suggestions. Any interaction between a subject and a belief-system including health care will influence the expectations for the future.

The frontal lobes play an important role in emotional regulation by direct influence on several subcortical regions, e.g. the amygdalae and the rostral anterior cingulate cortex. Numerous studies have at this point demonstrated the functional anatomical co-localization of the mechanisms for emotional regulation and the subject expectancy effect.

Time has come to more systematically study the placebo phenomenon in the framework of the psycho-social effect of encountering different forms of therapies. While conventional medicines tend to disregard the effects of suggestion, many alternative care-givers exploit the suggestive potential of the patient-care provider interaction to its fullest. A better understanding of the neurobiology of the placebo responses could form the basis for designing a truly integrative care process. This could potentially maximize the therapeutic outcome for the patient.

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