All posts by Michael Doneman

A steroid shot for your knee pain? Just skip it!

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. They have been commonly prescribed for sufferers of knee pain and inflammation, called synovitis, or knee osteroarthritis. In common with most steroids, these drugs are associated with a wide variety of adverse side effects. Depending on the dose, these may include:

Elevated pressure in the eyes (glaucoma)
Fluid retention, causing swelling in your lower legs
High blood pressure
Problems with mood, memory, behavior and other psychological effects
Weight gain, with fat deposits in your abdomen, face and the back of the neck

Taking the drugs over a longer period may produce:

Clouding of the lens in one or both eyes (cataracts)
High blood sugar, which can trigger or worsen diabetes
Increased risk of infections
Thinning bones (osteoporosis) and fractures
Suppressed adrenal gland hormone production
Thin skin, bruising and slower wound healing

A recent study (full text here) has shown that a group of patients injected with a corticosteroid medication over two years showed no decrease in pain, relative to a group taking placebos. However, the ‘placebo group’ did not suffer the loss of cartilage (indicating progression of the condition) over that period.

‘CONVERSATION’ AND THE PLACEBO EFFECT

From the earliest days of placebo research the practitioner-patient relationship has been at the heart of theorising about its effectiveness in therapy (and in life!)

Here’s an article that explores ‘the conversation’ and its beneficial placebo effects.

” … it’s no surprise that chronic arthritis and back pain are the second and third most common non-acute reasons that people go to the doctor and that pain costs America up to $635 billion annually. The pain remedies developed by the pharmaceutical industry are only modestly effective, and they have side effects that range from nausea and constipation to addiction and death.

What’s often overlooked is that the simple conversation between doctor and patient can be as potent an analgesic as many treatments we prescribe.”

… and …

“It’s clear that how doctors and nurses communicate their treatment can have profound effects on how patients experience the results of that treatment. Yet the conversation between doctors and patients is one of the least valued aspects of medical care. Insurance reimbursements for tests and medical procedures dwarf reimbursements for talking to patients or spending time thinking about what ails them. And the pharmaceutical industry, with its direct-to-consumer advertising, has promulgated the fallacy that every ailment must be met with a pill — brand name, of course.”

Is acupuncture a placebo?

In a report published in the National Institute for Health Research (NIHR) Journals Library, the researchers showed that there is significant evidence to demonstrate that acupuncture provides more than a placebo effect.

Professor of Acupuncture Research, Hugh MacPherson, working with a team of scientists from the UK and US, brought together the results of 29 high quality clinical trials focused on patients treated with acupuncture and standard medical care.

In the majority of these trials, patients with chronic pain treated with acupuncture and standard medical care were tested against those who were provided with standard medical care alone, such as anti-inflammatory drugs and physiotherapy. The trials involved approximately 18,000 patients diagnosed with chronic pain of the neck, lower back, head, and knee.

The report shows that the addition of acupuncture compared to standard medical care alone significantly reduced the number of headaches and migraine attacks and reduced the severity of neck and lower back pain. It also showed that acupuncture reduced the pain and disability of osteoarthritis, which led to patients being less reliant on anti-inflammatory tablets to control pain.

Read the full article here.

Broken heart? You need a placebo!

All over the interwebs right now!

Researchers at the University of Colorado-Boulder studied 40 recently jilted volunteers and found they displayed less physical pain and felt better emotionally — even after receiving a fake drug.

“Breaking up with a partner is one of the most emotionally negative experiences a person can have, and it can be an important trigger for developing psychological problems,” said the study’s lead author, Dr. Leonie Koban.

“In our study, we found a placebo can have quite strong effects on reducing the intensity of social pain,” she said.

Among the myriad stories covering this, check out the New York Daily News, MedicalExpress, and Science Daily.

Why I Take Fake Pills

Here’s a fascinating story from a writer at the Smithsonian who experienced that the placebo effect is engaged even if you KNOW you’re taking a sugar pill.

“I was in grad school training as a psychotherapist,” (Kelley) told me once, “and I came across a study arguing that antidepressants work just as well as psychotherapy. I didn’t mind that so much, because I like psychotherapy and see its value. But later I found another study showing that antidepressants actually work no better than placebos, and that definitely bothered me. Did this mean that psychotherapy was nothing but a placebo? It took me quite a while to consider the reverse, that placebo is a form of psychotherapy. It’s a psychological mechanism that can be used to help people self-heal. That’s when I knew I wanted to learn more.”

It seems that here at Universal Placebos we’re selling ‘open label’ placebos, that is, placebos explicitly labeled as placebos. It’s so nice that science is catching up!

In his research, which includes a wonderful ‘one person experiment’ designed to use placebos in tackling writer’s block, the author interviews Kathryn Tayo Hall, a geneticist at Brigham and Women’s Hospital, and ‘sheepishly’ admits to the fact that placebos worked for him.

“Brilliant,” she said, and showed me a box of homeopathic pills she takes to help with pain in her arm from an old injury. “My placebo. The only thing that helps.”

“I don’t have to believe in you,” (the author says directly to his placebo pills), “because you’re going to work anyway.”

‘Psychological Interventions’

A recent meta-study in the World Journal of Gastroenterology (March 28 2017) – Systematic review: The placebo effect of psychological interventions in the treatment of irritable bowel syndrome

Aim – “To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome.” (Six studies, with a total of 555 patients met the inclusion criteria.)

… and the placebo effect, unsurprisingly, figures significantly:

“Contrary to our expectations, the PRR (Placebo Response Rate) in studies on psychological interventions was comparable to that in studies on pharmacological, dietary and alternative medical interventions.”

Download the whole study in PDF here.

Placebo response and “Mindsets”

The research effort on the placebo effect deepens and widens.

“In a report published online Feb. 15 in The BMJ, researchers at Stanford call for more health care providers to place emphasis on the importance of individual mindsets and social context in healing … (and) to develop more studies that measure the physical effects of these psychosocial elements to understand and quantify patients’ subjective experiences of expectations, connection and trust.”

“We have long been mystified by the placebo effect,” Crum said. “But the placebo effect isn’t some mysterious response to a sugar pill. It is the robust and measurable effect of three components: the body’s natural ability to heal, the patient mindset and the social context. When we start to see the placebo effect for what it really is, we can stop discounting it as medically superfluous and can work to deliberately harness its underlying components to improve health care.”

Read the article here.

Suggestible You

In his book, ‘Suggestible You: The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal’ author Erik Vance explores placebos, hypnosis, and how beliefs influence bodily responses to pain.

“Placebos and beliefs generally is so much a part of our lives,” he tells Kishore Hari on a recent episode of the Inquiring Minds podcast. “It has an amazing power to change our bodies.”

Read the article here, or listen to the Podcast!

 

Branding Research Shows Placebo Effect on Consumers

“I was just amazed that you could change what price you were going to launch a product at, and you could change what brand it was, and people would have dramatically different impressions of that product. And they would tell you incredibly different things about the product: they thought it was made of different materials, they thought it weighed more or it weighed less. Really out-there stuff that, at the time, we joked about but we couldn’t explain.”

More here. And meanwhile, for your listening pleasure …