Tag Archives: Placebo Effect

Who is More Likely to Experience a Strong Placebo Effect?

A new study finds that people who have a better handle on their negative emotions may be more likely to experience a stronger placebo effect. Researchers at the University of Luxembourg found that participants who were better at interpreting negative events in a positive light felt more relief from a placebo pain-relieving cream.

The placebo effect has traditionally been viewed in a negative light; however, within the last decade, researchers have investigated the placebo effect itself and found that placebos can trigger real biological changes in the body, including the brain.

In a related article:

“All participants reported less pain: the placebo effect was working. Interestingly, those with a higher capacity to control their negative feelings showed the largest responses to the placebo cream in the brain. Their activity in those brain regions that process pain was most reduced. This suggests that your ability to regulate emotions affects how strong your response to a placebo will be.”

PLACEBO AND FAKE SURGERY

Two thought-provoking articles relating the placebo effect to ‘sham surgery’, which has been canvassed in these pages previously.

In this meta-study, the authors point out that ” the literature is not chock full of studies comparing a surgical procedure to placebo. While the study of a drug versus placebo is standard practice, the picture changes radically when the placebo is a sham operation involving incisions and anesthesia …  Of about 3000 articles, 53 full-text articles were selected. They represented randomized controlled studies, with both an active intervention and a placebo arm involving a sham procedure. The authors defined a surgical outcome based on three elements:

•    The critical surgical component – the anatomic changes felt to result in a therapeutic effect

•    Placebo component – the patient’s expectations

•    Non-specific effects – changes in the natural history of an illness that might impact the outcome, the experience of being in a hospital, interactions with staff – the multitude of other factors.

In this study, the author admits that sham (placebo) srugery already occurs. Because it can work.

How?

“How can sham surgeries work? Bigness. In the same way that placebo pills and other modalities make people get better, the clinical evaluation, workup, stress and travel of surgery day, surgical prep, etc. all make for an almost unbeatable set of placebo-instituting conditions. And with some of the data which exist, sham surgeries perform better in the patients’ minds than a drug treatment that’s a comparator for the same condition.

Placebos and acupuncture

Here’s a link to a fascinating meta-analysis of the effectiveness of acupuncture in the treatment of chronic pain, controlling for some of the dodgy and unscientific ‘studies’ out there.

In this article, the outcomes of the study are listed and discussed, and it’s good news for acupuncturists.

‘When comparing legit acupuncture to standard care, there was a statistically significant benefit to acupuncture … “We saw a measurable effect there,” he explains. “If acupuncture were a drug, we’d say the drug works.”’

…and later, in relation to the placebo effect:

‘Many people equate placebo effects with scams. “The term placebo has always had this very negative connotation,” says Vitaly Napadow, director of the Center for Integrative Pain Neuroimaging at Harvard Medical School. But Napadow says our poor opinion of placebo needs revising. The human body has built-in systems for stoking or calming pain and other subjective sensations. “If a placebo can target and modulate these endogenous systems, that’s a good and a real thing,” he says.’

Meanwhile, in two comprehensive studies into the value of acupuncture treatment in treating women’s health issues, we see mixed results.

‘These studies shed new light on when and when not to consider using acupuncture,” Dr. Josephine Briggs and David Shurtleff, of the U.S. National Center for Complementary and Integrative Health, wrote in an editorial to accompany the studies.

The research done to date on acupuncture has shown that, generally, its benefits are limited to outcomes that are subjective, such as pain, Briggs and Shurtleff wrote. People’s positive expectations and the reassurance they feel from the procedure likely contribute to the benefits. “Clearly these ancient practices are helping reveal the complexity of the links between the mind and the body,” the editorial said.’

Yes, the placebo effect is all in your mind. And it’s real.

It seems that the research on the placebo effect is broadening and deepening.

“Over the last several years, doctors noticed a mystifying trend: Fewer and fewer new pain drugs were getting through double-blind placebo control trials, the gold standard for testing a drug’s effectiveness.”

This recent article, which includes some useful links for further reading, points to the degree in which the placebo effect (classified by the writer as a ‘family of overlapping psychological phenomena’) is being studied and considered. The family of placebo effects ranges ‘from the common sense to some head scratchers’, and include:

1) Regression to the mean
2) Confirmation bias
3) Expectations and learning
4) Pharmacological conditioning (‘This is where things get a little weird’)
5) Social learning
6) A human connection

Interestingly, it seems that at least in pain studies, ‘there’s evidence that placebos actually release opioids in the brain’.

In another article in Mother Jones, What the Heck Is a Placebo Anyway?, the authors propose ‘… we now know that they (placebos) often involve real chemicals produced by the body—real drugs from your “internal pharmacy.” Some of these chemicals are used by the brain to make sure that your expectation meets reality. When expectation doesn’t meet reality, the brain steps in and forces it to fit.’

Over at Fox News (of all people), quoting the Wall Street Journal, they’re suggesting ‘Placebo drugs really work, evidence suggests‘.

Placebo ‘drugs’? Come on, folks, that misses the point a bit!

‘Mind Body’ Healing: The placebo effect and exercise

Damien Finniss was working as a physiotherapist when, on a still winter’s afternoon in 2001, he set up his treatment table in a shed at the perimeter of a Sydney footy ground.

As players came off with sundry aches – a pulled hammy here, a calf strain there – Finniss ministered to them with therapeutic ultrasound, a device that applies sound waves to the injured area with a handheld probe.

“I treated in excess of five or six athletes during the training session. I’d treat them for five or 10 minutes and they’d say ‘I feel much better’ and run back on to the training field,” recalls Finniss, now a medical doctor and Associate Professor at the University of Sydney’s Pain Management and Research Institute.

“But, at the end of the session, I realised that I’d, basically, had the machine turned off.”

Read the whole article here.

Meanwhile, in Germany, researchers reveal some convincing evidence of the impact of the placebo effect, discovering that “a person’s expectations have a major influence on just how strenuous they perceive exercise to be.”

 

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.

‘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!