Riassunto : L’ effetto nocebo è l’effetto psicobiologico dovuto al contesto psicosociale negativo che accompagna una terapia. Dal momento che lo studio dell’ anticipazione dolorifica prende in considerazione la fase temporale della “attesa dell’iperalgesia”, e considerando che – proprio come il nocebo – è possibile elicitarla con il solo uso di verbalizzazioni negative, questo modello può permettere di studiare la risposta nocebo. Ad oggi infatti non si dispone di dati univoci circa le aree coinvolte in questi processi e circa il (...) ruolo cognitivo da queste ricoperto. Abbiamo condotto una meta-analisi su studi fMRI di anticipazione dolorifica su cui applicare un modello di connettività meta-analitica su due regioni di interesse: la corteccia cingolata e l’insula anteriori, le cui attivazioni sembrerebbero correlano ai domini comportamentali dell’azione, dell’emozione e della percezione. I risultati avvalorano l’ipotesi dell’esistenza di un sistema supramodale altamente distribuito, attivato dall’anticipazione del dolore, e, infine, volto all’elaborazione delle informazioni e all’auto-regolazione delle risposte adattive all’ambiente. Parole chiave : Placebo; Nocebo; Dolore; Correlati neurali; Comportamento umano Placebo Analgesia, Pain Anticipation, and the Possible Neural Correlates of Nocebo Effect: The nocebo effect is a psychobiological effect that occurs when a negative psychosocial context that accompanies a therapy. Since the study of pain anticipation takes into account the temporal phase of the “expectation of hyperalgesia”, and considering that it is possible to stimulate such anticipatory processes merely through the use of negative verbalizations, this model is appropriate for studying the nocebo response. To date, there are no univocal data about the brain areas involved in these processes or their cognitive roles. We conducted a meta-analysis on pain anticipation fMRI studies. We then applied a meta-analytic connectivity model to activations in the anterior cingulate cortex and the anterior insula, which correlate with the behavioral domains of action, emotion and perception. Our results support the hypothesis that there is a highly-distributed supramodal system, activated by pain anticipation, for processing information that enhances the self-regulation of adaptive responses to the environment. Keywords : Placebo; Nocebo; Pain; Neural Correlates; Human Behaviour. (shrink)

One of the most promising trends both in the neuroscience of pain and in psychiatric treatments of chronic pain is the focus on mental imagery. My aim is to argue that if we take these findings seriously, we can draw very important and radical philosophical conclusions. I argue that what we pretheoretically take to be pain is partly constituted by sensory stimulation-driven pain processing and partly constituted by mental imagery. This general picture can explain some problematic cases of pain perception, (...) for example, phantom-limb pain, and it also has important consequences for some recent philosophical debates about the nature and content of pain. (shrink)

Representationalist theories of phenomenal consciousness have problems in accounting for pain, for at least two reasons. First of all, the negative affective phenomenology of pain (its painfulness) does not seem to be representational at all. Secondly, pain experiences are not transparent to introspection in the way perceptions are. This is reflected, e.g. in the fact that we do not acknowledge pain hallucinations. In this paper, I defend that representationalism has the potential to overcome these objections. Defenders of representationalism have tried (...) to analyse every kind of phenomenal character in terms of indicative contents. But there is another possibility: Affective phenomenology, in fact, depends on imperative representational content. This provides a satisfactory solution to the aforementioned difficulties. (shrink)

Premenstrual dysphoric disorder was recently moved to a full category in the DSM-5 . It also appears set for inclusion as a separate disorder in the ICD-11 . This paper argues that PMDD should not be listed in the DSM or the ICD at all, adding to the call to recognise PMDD as a socially constructed disorder. I first present the argument that PMDD pathologises understandable anger/distress and that to do so is potentially dangerous. I then present evidence that PMDD (...) is a culture-bound phenomenon, not a universal one. I also argue that even if medication produces a desired effect, there are biological correlates with premenstrual anger/distress, such anger/distress seems to occur monthly, and women are more likely than men to be diagnosed with affective disorders, none of these factors substantiates that premenstrual anger/distress is caused by a mental disorder. I argue that to assume they do is to ignore the now accepted role that one’s environment and psychology play in illness development, as well as arguments concerning the social construction of mental illness. In doing so, I do not claim that there are no women who experience premenstrual distress or that their distress is not a lived experience. My point is that such distress can be recognised and considered significant without being pathologised and that it is unethical to describe premenstrual anger/distress as a mental disorder. Further, if the credibility of women’s suffering is subject to doubt without a clinical diagnosis, then the way to address this problem is to change societal attitudes towards women’s suffering, not to label women as mentally ill. The paper concludes with some broader implications for women and society of the change in status of PMDD in the DSM-5 as well as a sketch of critical policy suggestions to address these implications. (shrink)