Treatment outcomes are strongly influenced by expectations, as evidenced by the placebo effect. Meta-analyses of clinical trials reveal that placebo effects are strongest in pain, indicating that psychosocial factors directly influence pain. In this review, I focus on the neural and psychological mechanisms by which instructions, learning, and expectations shape subjective pain. I address new experimental designs that help researchers tease apart the impact of these distinct processes and evaluate the evidence regarding the neural mechanisms by which these cognitive factors shape subjective pain. Studies reveal that expectations modulate pain through parallel circuits that include both pain-specific and domain-general circuits such as those involved in affect and learning. I then review how expectations, learning, and verbal instructions impact clinical outcomes, including placebo analgesia and responses to pharmacological treatments, and discuss implications for future work.

中文翻译：

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指示、学习和期望如何塑造疼痛和神经生物学反应

治疗结果很大程度上受到期望的影响，安慰剂效应就证明了这一点。临床试验的荟萃分析表明，安慰剂效应在疼痛中最强，表明心理社会因素直接影响疼痛。在这篇评论中，我重点关注指令、学习和期望塑造主观疼痛的神经和心理机制。我提出了新的实验设计，帮助研究人员梳理这些不同过程的影响，并评估有关这些认知因素塑造主观疼痛的神经机制的证据。研究表明，期望通过并行回路调节疼痛，这些并行回路包括疼痛特定回路和通用域回路，例如涉及情感和学习的回路。然后，我回顾期望、学习和口头指示如何影响临床结果，包括安慰剂镇痛和对药物治疗的反应，并讨论对未来工作的影响。