Neuroimaging as a tool to investigate how cognitive factors influence analgesic drug outcomes

The observation that cognitive factors such as beliefs and expectations not only modulate the perception of pain, but also the therapeutic benefit and adverse effects of any pharmacological treatment is not new. However, the contribution of cognitive factors to pharmacotherapy is still poorly understood and far from being systematically exploited to maximize treatment outcome. Recent insights into placebo and nocebo phenomena and their underlying neurobiological mechanisms have, however, rekindled the interest in interactions between pharmacological effects and cognitive factors. In this review, we argue that modern non-invasive neuroimaging techniques exploring structure and function of the brain as well as neurochemical processes can aid in understanding these potential interactions at a more fundamental level. Taking pain as an example, we portrait recent advances in this field and discuss basic science and clinical implications.