Chapter 3 – Comprehensive review 91 Discussion This review provides an overview of the neurobiological correlates of experimentally induced nocebo hyperalgesia. fMRI findings showed that activity might be amplified already in the spinal cord and further modulated by higher cognitive representations, such as cognitive and affective processes. Electrophysiological findings, though limited, also pointed towards involvement of cognitive-affective processes. Neurochemical findings were not consistent on whether cortisol may play a role in nocebo hyperalgesia, but pointed towards an involvement of specific endogenous neurotransmitter systems. Due to the multifaceted nature of nocebo hyperalgesia as a learned effect, physiological components remain difficult to disentangle from other variables, such as cognitive mechanisms related to sensory perception. Central issues arising from the compilation of neurobiological findings from the nocebo literature are the widespread inconsistency in methods used and results yielded, –albeit this being understandable given the youth of the nocebo field. This diversity in methods and reporting of findings seriously challenges the interpretation of these findings. In discussing the results of this review, we have attempted to broadly categorize findings into neurobiological processes. It should be noted that this compartmentalization adds clarity to the interpretation of the results, the boundaries between these categories are blurred and categories largely overlap. Sensory discrimination Sensory discrimination allows for the processing of details both within the sensory input and between distinct types of sensations. It is
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