Influence du sommeil sur l'analgésie placebo
Pain is a multidimensional experience which can be modulated by many cognitive factors. The impact of expectations associated with an impending painful experience was largely studied in the context of placebo analgesia, and it was suggested that the presence of conscious relief expectation was necessary for the production of pain reduction. On the other hand, some clinical studies have observed therapeutic improvements following the administration of a placebo, even during sleep, which suggest that a placebo effect can be seen even in the absence of explicit relief expectation. The first study of this thesis aims at examining if a pain reduction, as well as a decrease in sleep disturbances associated with the experimental pain stimuli, can be seen following the induction of night-time expectations. The results indeed showed a significant reduction in pain and associated sleep disturbances evaluated retrospectively following the application of a placebo. In addition, placebo treatment appears to modulate responses to experimental pain during sleep, in a manner dependent of the sleep stage in which they are presented. Although the development of placebo analgesia relies on the production of relief expectations, previous exposure to efficient treatment appears to augment the magnitude of the effect. This suggests that associative learning processes might also be implicated in the genesis of these effects. As a role of sleep was shown in the learning of different aptitudes, the objective of the second study was to examine whether the presence of a sleep episode between the placebo induction and the evaluation of the effect can reinforce the integration of expectations and consequently, favour the production of expectation-dependent effects. The results show that sleep increases the association between expectation and relief, and that the level of expectation appears to be linked to the relative duration of REM sleep measured after the induction. Globally, this thesis demonstrates that sleep can influence placebo analgesia at many levels.
Placebo analgesia Sleep Expectation REM sleep Conditioning