Our perception of the external world is strongly modulated by our own theories, experiences, beliefs and expectations. An emblematic case of this phenomenon is represented by the so-called “placebo effect”. Until now, most of the studies investigated the effects of placebo on the sensory systems, in particular on nociception. In the current study we aimed at addressing a still partially uncovered issue, which is the neurophysiologic bases of the effect of expectation, induced through a placebo procedure, on motor performance. Subjects were assigned to three groups: experimental ( N = 13), control-1 ( N = 13) and control-2 ( N = 13). Participants had to press a piston connected to a force transducer, with the index finger. Finger pressures against the piston were converted into vertical cursor’s displacements on a PC monitor. Subjects were asked to press as strongest and fastest as possible. The protocol included three sessions: baseline, experimental manipulation and final. In control-2 group all the sessions were equal. In the experimental and control-1 groups, the baseline and final sessions were identical, whereas the experimental manipulation consisted in the application of a fake treatment (low frequency transcutaneous electrical nerve stimulation, TENS), accompanied by different verbal instructions to the two groups. The experimental group was told that TENS was an effective way to enhance force, whereas the control-1 group was told that TENS was inefficient in influencing force. In addition, soon after TENS, the experimental group underwent a conditioning procedure consisting in the surreptitious magnification of the cursor’s excursion range, so as to make subjects believe that the treatment was really effective. All the participants underwent transcranial magnetic stimulation (TMS) over the primary motor cortex before and after treatment (for control-2 we applied TMS pulse at the same time as in the other groups, but without treatment), and motor evoked potentials (MEP) were measured from the FDI and ADM muscles. TMS was delivered for all participants at the 30% of the maximal voluntary contraction. Neurophysiological (MEP amplitude and cortical silent period, CSP, duration) and behavioral measures (force level, subjective feeling of force, sense of extent) were compared in the baseline and final sessions and across groups. With respect to the baseline, in the final session the experimental group showed higher force levels ( p = 0.050), higher MEP amplitude ( p = 0.022) and lower CSP duration ( p = 0.007). On the contrary, in the two control groups the level of force, MEP and CSP did not change between the two sessions ( p > 0.050). These findings suggest that the proposed protocol is successful in inducing improvement of motor performance and hint at an enhancement of cortico-spinal activation due to a motor-placebo-like procedure.
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