Quite a buzz lately about the placebo effect and back pain, extending from a randomized control trial in Portugal.
“Our findings demonstrate the placebo effect can be elicited without deception. Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered.” – Lead author Claudia Carvalho, Ph.D., ISPA
“It’s the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our healthcare system,” (says placebo researcher Ted Kaptchuk, Professor of Medicine at Harvard Medical School). “The body responds to that.”
While this study focused on chronic pain, Kaptchuk says it is possible that patients with other conditions that involve self-observation – such as fatigue, depression, or digestive problems – may benefit from open-label placebo treatment.
“You’re never going to shrink a tumor or unclog an artery with placebo intervention,” notes Kaptchuk. “It’s not a cure-all, but it makes people feel better, for sure. Our lab is saying you can’t throw the placebo into the trash can. It has clinical meaning, it’s statically significant, and it relieves patients. It’s essential to what medicine means.”
Read the whole article here, and another here.
It seems that the placebo ‘hierarchy’ still plays out – a pill is trumped by a saline injection, which is trumped by ‘surgery’. Studies suggest that patients in the USA are opting for ineffective knee surgery in the belief this will relieve pain, even though it is likely that such an effect is … well, a placebo effect
“I personally think the operation should not be mentioned.” … But if a doctor says anything, Dr. Guyatt suggests saying this: “We have randomized clinical trials that produce the highest quality of evidence. They strongly suggest that the procedure is next to useless. If there is any benefit, it is very small and there are downsides, expense and potential complications.”
So you want to run faster — but you’re not ready for steroids?
No problem: just swallow a pill made of sugar and water that you think is a steroid — and you’ll run faster, because you believe you can.
A recent Scottish study found runners told they were getting performance-enhancing pills felt stronger and ran faster than normally — even though the pills were fake.
It’s just the latest example of the Placebo Effect, one of the most powerful effects known to humans, along with the Greenhouse Effect, the Brexit Effect and the Trump Defect.
Placebos are fake drugs you think are real — and a third of the time, they’re more effective than most drugs in the pharmacy at reducing everything from headaches, pain, nausea, coughs and colds to anxiety caused by fear that the pills your doctor gave you are actually placebos.
Read the full article here.
“A common operation for back pain is not only ineffective but often leads to complications, a former spinal surgeon is claiming in a new book. In Surgery, The Ultimate Placebo Ian Harris says that when spine fusion operations appear to work, it’s usually because of a placebo effect.” Full article here
Research published in August 2015 (Increasing placebo responses over time in U.S. clinical trials of neuropathic pain) and published in the Journal Pain focused on over two decades’ worth of clinical trials – 80 in all. The results showed that, as many have speculated, our placebo response is indeed getting stronger. And, because one measure of a drug’s effectiveness is its ability to perform better than the placebo, more pain-drug trials are failing than in the past. But, interestingly, the researchers found that this increase was only true for studies conducted in the U.S.
1. Find people in pain.
2. Enroll them in a study.
3. Admit you can’t do much to help.
4. Give them a fake pill.
5. Tell them that’s exactly what you are doing.
But here’s the crazy thing: It works.
Research is ongoing into the role of the subconscious mind in triggering both the placebo and ‘nocebo’ effect in humans, with considerable implications for health care if the research is borne out in practice. As we’ve seen elsewhere in this blog, it is quite routine, for example, for conventional medical providers to knowingly prescribe mock or ineffectual medications (such as antibiotics for viral conditions), given patient expectations and for that matter social norms. This has not been named as knowingly prescribing placebos, or knowingly invoking the placebo effect, but the research is mounting!
Lifestyle guru Deepak Chopra says: “The first step toward an alternative is to view pain as a mind-body experience that is highly subjective. As such it can often be approached through a phenomenon called “self-efficacy.” The brain contains many pain-relieving chemicals, and these can be triggered mentally, which is why taking a placebo leads to pain relief in a significant proportion of people. (The reverse is also true through the nocebo effect, where a harmless substance induces pain or fails to relieve it when the subject is told that this is the expected outcome.)”
His take on ‘America’s Pain-Pill Epidemic’ can be seen in full here.
Recent research, published in The Lancet, reveals that paracetomol, the ‘recommended first-line analgesic for acute low back pain’, is no more effective than placebo treatment. Put another way, a placebo is just as likely to generate relief as paracetomol. If you don’t want to read the Lancet report (it’s pretty dry!), there’s a brief article here.