[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-137803-105":59,"doc-detail-137803-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","spinal-and-supraspinal-mechanisms-of-placebo-analgesia-chapter-overview","Spinal and Supraspinal Mechanisms of Placebo Analgesia - Chapter Overview","","Pain perception does not always scale with nociceptive input, and psychological factors can reduce perceived pain under experimentally controlled conditions such as suggestion, expectations, or attention shifts. Placebo analgesia is highlighted as a widely investigated form of psychological pain modulation shaped by multiple cognitive factors and neurobiological pathways. The chapter examines an early neurobiological account in which descending opioid-dependent pain control modulates nociceptive processing at the spinal cord and contributes to placebo effects. It reviews evidence from animal studies and human fMRI, then focuses on spinal cord contributions and fMRI methodological challenges.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/spinal-and-supraspinal-mechanisms-of-placebo-analgesia-chapter-overview/137803/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/spinal-and-supraspinal-mechanisms-of-placebo-analgesia-chapter-overview/137803.png","ImageObject",300,407,{"name":92,"@type":93},"Xiajie","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-20","2026-08-23",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why does perceived pain not always match nociceptive input?","Question",{"text":112,"@type":113},"Pain is subjective and can deviate from a simple monotonic relationship with nociceptor stimulation. Psychological and contextual factors can reduce pain even when nociceptive input is present.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What mechanisms are proposed to underlie placebo analgesia?",{"text":117,"@type":113},"Placebo analgesia is proposed to involve multiple psychological determinants and distinct neurobiological mechanisms. A central early explanation emphasizes a descending pain control system with opioidergic neurotransmission acting on spinal nociceptive processing.",{"name":119,"@type":110,"acceptedAnswer":120},"Which brain and spinal cord structures are central to descending pain control?",{"text":121,"@type":113},"The periaqueductal gray (PAG) and the rostral ventromedial medulla (RVM) form a core system. Their projections modulate the dorsal horn of the spinal cord, inhibiting nociceptive processing and influencing the overall pain experience.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},137803,1787447715,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":56,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":129,"read_time":143},8814010472675,"https://avatar.qwps.com/avatar/WGlhamll","Spinal and Supraspinal Mechanisms of Placebo Analgesia  \nFalk Eippert 1 , Christian Büchel2  \n1Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB), University of Oxford, Oxford, UK, 2Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany  \nINTRODUCTION  \nPain is a subjective experience that is not invariably related to the amount of nociceptive input to the central nervous system. While a monotonic relationship between strength of nociceptor stimulation and perceived pain intensity is often observed,1,2 deviations from such a relation are just as abundant and are probably best appreciated in extreme cases where a traumatic injury does not lead to a strong feeling of pain, as in competition or combat.3 Such a reduction of pain perception—although certainly to a lesser extent—can also be induced experimentally, as for example via hypnotic suggestions,4 expectations of reduced pain,5 or attentional distraction.6  \nPlacebo analgesia is thus just one example of the impact that psychological factors can have on pain perception, yet due to the pervasiveness of placebo effects in clinical trials, it is possibly one of the most investigated forms of psychological pain modulation. It has become clear that placebo effects in pain are determined by multiple psychological factors and rely on various different neurobiological mechanisms.7–14 In this chapter we look at one of the earliest explanations of placebo analgesia at the neurobiological level,15 namely, that a descending pain control system, which relies heavily on opioidergic neurotransmission and controls nociceptive processing already at the level of the spinal cord, contributes to placebo effects in pain.  \nIn the following, we first give an overview of descending pain control as established in animal studies. We then move on to ask what evidence there is that descending control of pain underlies placebo analgesia; we focus on studies using functional magnetic resonance imaging (fMRI) of the human brain. Finally, we move away from  \nthe brain and, instead, look at the role of the spinal cord for placebo effects in the context of pain, again focusing on fMRI data (as well as the challenges that exist in spinal fMRI) .  \nTHE ANATOMY OF DESCENDING PAIN CONTROL  \nThe functional neuroanatomy of pain processing isnot a one-way road starting in the body periphery and ending in the cerebral cortex; instead, it contains both ascending pathways (i.e. from the body periphery over the spinal cord to higher brain structures) and descending pathways (i.e. from higher brain structures to the spinal cord; Fig. 7.1) . Nociceptive information from the body periphery reaches the central nervous system via primary afferents that terminate in the dorsal horn of the spinal cord. The main targets of nociceptive afferents are the superficial laminae I and II, although some also synapse in the deeper laminae of the dorsal horn; these also play a prominent role in nociceptive processing (especially lamina V and its wide-dynamic-range neurons) . The dorsal horn contains a large number of inhibitory and excitatory interneurons, which allows for complex processing of nociceptive information. From the dorsal horn, nociceptive information is transmitted to numerous higher regions via several ascending pathways to specific parts of the brainstem, midbrain, thalamus and hypothalamus amongst others, and eventually reaches the cortex. Modulation of spinal nociceptive processing, i.e. a modulation at the earliest station of nociceptive input to the central nervous system, will therefore have a profound effect on subsequently  \nPAG  rACC Hypothalamus  \nRVM  \nSpinal cord  \nFIGURE 7.1 Neuroanatomy of descending pain control. This simplified diagram shows key regions involved in opioidergic descending pain control, as identified by both animal studies and human imaging studies. The endpoint of this system is the spinal cord, where nociceptive processing is in","cbCailbnl3ZlmTBX","https://ap.wps.com/l/cbCailbnl3ZlmTBX","pdf",1273526,"English","# Introduction\n## Placebo analgesia and psychological pain modulation\n## Descending pain control overview\n# The anatomy of descending pain control\n## Ascending and descending pathways\n## Gate control framework and key nuclei\n## PAG–RVM projections and spinal modulation","[{\"question\":\"Why does perceived pain not always match nociceptive input?\",\"answer\":\"Pain is subjective and can deviate from a simple monotonic relationship with nociceptor stimulation. Psychological and contextual factors can reduce pain even when nociceptive input is present.\"},{\"question\":\"What mechanisms are proposed to underlie placebo analgesia?\",\"answer\":\"Placebo analgesia is proposed to involve multiple psychological determinants and distinct neurobiological mechanisms. A central early explanation emphasizes a descending pain control system with opioidergic neurotransmission acting on spinal nociceptive processing.\"},{\"question\":\"Which brain and spinal cord structures are central to descending pain control?\",\"answer\":\"The periaqueductal gray (PAG) and the rostral ventromedial medulla (RVM) form a core system. Their projections modulate the dorsal horn of the spinal cord, inhibiting nociceptive processing and influencing the overall pain experience.\"}]","Spinal and Supraspinal Mechanisms of Placebo Analgesia - Chapter Overview | PDF",48]