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26th Napa Pain Conference

NPC26-Sa1 - 5th Annual Legacy Lecture: How Expectations Shape Pain

Aug 17, 2019 8:00am ‐ Aug 17, 2019 8:45am


5th Annual Legacy Lecture

How Expectations Shape Pain

Honoring the Legacy of our Leaders

Howard L. Fields, MD, PhD
Founder, UCSF Pain Management Center
Director, Wheeler Center for the Neurobiology of Addiction, University of California, San Francisco
Professor Emeritus of Neurology and Physiology, UCSF Center for Integrative Neuroscience

Target Audience: Clinicians & researchers addressing acute or chronic pain

Howard Fields, MD, PhD founded the University of California, San Francisco Pain Management Center and made major contributions to the understanding and treatment of neuropathic pain, and the understanding of mechanisms of pain modulation and placebo analgesia.

Dr. Fields’ major interests are in nervous system mechanisms of pain and substance abuse with a focus on how endogenous opioids contribute to these mechanisms. His group was the first to demonstrate the clinical effectiveness of opioids for neuropathic pain and of topical lidocaine for post-herpetic neuralgia. In laboratory studies he discovered and elucidated a pain modulating neural circuit that is required for opioids to produce analgesia. He also discovered that placebo analgesia is blocked by an opioid antagonist.

His recent work has centered on the problem of addiction, and he has begun to delineate the molecular and cellular circuitry of drug reward. His laboratory discovered nerve cells in the striatum that selectively encode the magnitude of a reward. They have also shown how the neurotransmitter dopamine contributes to motivation and reward based choice. His latest work focused on the neurobiology of opioid reward.

Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Apply an understanding of the roles that conditioning and expectations play in modulating the pain experience to the care of persons with chronic pain

Additional Reading

  • Cormier, S., Lavigne, G. L., Choinière, M., & Rainville, P. (2016). Expectations predict chronic pain treatment outcomes. Pain, 157(2), 329-338.
  • Keltner, J. R., Furst, A., Fan, C., Redfern, R., Inglis, B., & Fields, H. L. (2006). Isolating the modulatory effect of expectation on pain transmission: a functional magnetic resonance imaging study. Journal of Neuroscience, 26(16), 4437-4443.
  • Fields, H. (2004). State-dependent opioid control of pain. Nature Reviews Neuroscience, 5(7), 565.
  • Dum, J., & Herz, A. (1984). Endorphinergic modulation of neural reward systems indicated by behavioral changes. Pharmacology Biochemistry and Behavior, 21(2), 259-266.
  • Lord, J. A., Waterfield, A. A., Hughes, J., & Kosterlitz, H. W. (1977). Endogenous opioid peptides: multiple agonists and receptors. Nature, 267(5611), 495.
  • Knutson, B., Adams, C. M., Fong, G. W., & Hommer, D. (2001). Anticipation of increasing monetary reward selectively recruits nucleus accumbens. Journal of Neuroscience, 21(16), RC159-RC159.
  • Eippert, F., Finsterbusch, J., Bingel, U., & Büchel, C. (2009). Direct evidence for spinal cord involvement in placebo analgesia. Science, 326(5951), 404-404.
  • Johansen, J. P., Fields, H. L., & Manning, B. H. (2001). The affective component of pain in rodents: direct evidence for a contribution of the anterior cingulate cortex. Proceedings of the National Academy of Sciences, 98(14), 8077-8082


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