The reward for placebos: mechanisms underpinning placebo-induced effects on motor performance

Cayque Brietzke, Julio Cesar Silva Cesario, Florentina Johanna Hettinga, Flavio Oliveira Pires*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)
6 Downloads (Pure)


Different from the most popular thinking, the placebo effect is not a purely psychological phenomenon. A body of knowledge from multidisciplinary fields has shown that the expectation of a potential benefit when receiving a treatment induces a cascade of neurochemical-electrophysiological alterations in brain reward areas, including motor-related ones. Alterations in the dopamine, opioid, and glutamate metabolism are the neural representation converting reward-derived declarative forms into an attractive and wanted behavior, thereby changing the activation in reward subcortical and cortical structures involved in motor planning, motor execution, and emotional-cognitive attributes of decision-making. We propose that the expectation of receiving a treatment that is beneficial to motor performance triggers a cascade of activations in brain reward areas that travels from motor planning and motor command areas, passing through corticospinal pathways until driving the skeletal muscles, therefore facilitating the motor performance. Although alternative explanations cannot be totally ruled out, this mechanistic route is robust in explaining the results of placebo-induced effects on motor performance and could lead to novel insights and applications in the exercise sciences. Factors such as sex differences in reward-related mechanisms and aversion-induced nocebo effects should also be addressed.
Original languageEnglish
Pages (from-to)2321-2329
Number of pages9
JournalEuropean Journal of Applied Physiology
Issue number11
Early online date25 Aug 2022
Publication statusPublished - 1 Nov 2022


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