22 aspects of nocebo effects, thereby shedding light on novel aspects of brain processing under nocebo hyperalgesic conditions. We induced nocebo hyperalgesia by use of conditioning and negative suggestions and recorded EEGs before, during, and after nocebo acquisition and evocation. This EEG study enriched our understanding of the role that learning and nociceptive processing play in nocebo hyperalgesia. In Chapter 7 we present a pharmacological fMRI study that investigated neurochemical correlates of learning in nocebo hyperalgesia. In this randomized clinical trial, we aimed to pharmacologically manipulate NMDA receptors, known for mediating certain types of learning, such as associative learning involved in classical conditioning. fMRI methods allowed for the exploration of brain activations during nocebo acquisition and extinction. We used classical conditioning and negative suggestions to induce nocebo hyperalgesia in a group receiving a low dose of D-cycloserine (a known partial NMDA receptor agonist) and in a group receiving placebo. These manipulations and imaging methods served to explore how NMDA-dependent learning influences the formation of nocebo effects and several potentially relevant brain processes were identified. Chapter 8 is a general discussion relating to this dissertation. In this chapter the results of the conducted studies are summarized and connected to the aims of this PhD project. We then further discuss these aims in light of theoretical and practical implications.
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