How do expectations change – and what influence do they have on pain and the treatment of pain?

Thoughts, experiences, and expectations can strengthen or weaken our experience of pain, and strongly influence how well pain treatment will work for an individual person. But what are the psychological and neuronal mechanisms underlying this effect? How, and for what reasons, do people’s expectations change? And what consequences does this have for the success of individual pain treatment? To find some answers to these questions, in Project A01, we use functional magnetic resonance imaging (fMRI) to visualize study participants’ brain activity.

Negative expectations impact pain more strongly than positive expectations

In the first funding period of our Collaborative Research Centre, we have gained significant knowledge about how positive and negative expectations develop, how they are maintained, and how they change over time. The results so far suggest that negative expectations have stronger, and longer-lasting, effects on our experience of pain than positive expectations.

Another large controlled pharmacological trial showed that the dopaminergic system, with the neurotransmitter dopamine, is a key factor in the pain-inhibiting impact of placebo effects. And finally, we were able to identify certain brain regions whose interaction plays a role in the development of nocebo effects.

Focus on back pain, the noradrenergic system, and the ability to change expectations

In the second funding period, we would like to deepen this knowledge in Project A01 and extend it to investigations in patients with chronic back pain. In particular, we also want to look at the role of the noradrenergic system in changing expectations. The neurotransmitter noradrenaline is involved in the nervous system in the brain, and impacts, among other things, our emotions, sleep, attention, and learning processes. Additionally, we will focus on the dynamics and changes of expectations over time. For example, we will follow patients who are undergoing multimodal pain therapy over a longer period of time.