The Placebo And Pain Relief
'The Brain Can Do Wonders - And Turning Smarties Into Pain Killers Is Just One Of Them '
By Definition –
The ‘placebo effect’ is a term commonly used to describe a change in perceived symptoms by a patient as a result of a change in their belief. A ‘placebo’ is the action that has caused this change in belief. Below we analyse the role of the placebo and pain relief.
The Relevance Of The Placebo In Pain Management
Acceptance that you can change a patient’s opinion simply by giving them a sugar pill with nothing in it has changed modern medicine in to the form it is today where every new drug must first be tested against a placebo to measure it’s true impact.
The concept of a placebo however is a simple one – you give 100 people a new drug and 35% say it improved their pain relief. Sounds good?
Well, what if you gave another 100 people a tablet that looks exactly the same, but has no drug in it at all and tell them it’s the new drug. Then 30% come back and say it improved their pain relief by the same margin as the first group?
What do you have (besides a placebo-controlled trial)? A drug that only really improves the likelihood of a positive outcome by 5%.
Without measuring the placebo effect, you might falsely assume the benefit was 35% seeing a big improvement in symptoms.
The Placebo And Pain Relief – The ‘Game Changer’
So what happened?
The placebo effect is what happened. The second group all thought they were taking the new drug and so expected to see some improvement in symptoms.
In the case of 30% of them, they expected so hard to see an improvement that their brains actually changed the way they dealt with pain and negative transmissions.
Effectively, their brains reduced the symptoms they were experiencing precisely because they were expecting to see an improvement.
Now not so long ago, this was assumed to be a largely ‘fake’ response, and it was simply considered that your perception of your symptoms was incorrect.
Even the ever-reliable Oxford Dictionary has got it wrong –
“a substance that has no therapeutic effect, used as a control in testing new drugs”
To say a placebo has ‘no therapeutic effect’ is in today’s medical world simply not true.
A placebo may have no clinically significant ingredients, but it does have a therapeutic effect!
In the same way that we now accept hypnosis can help people stop smoking or reduce pain perception.
We also accept the many mindful techniques such as The Feldenkrais method, The Alexander Method, Cognitive Behvioural Therapy and many others all have a place in modern medicine.
What all of these practices teach is that the brain is a miraculous invention that we still do not fully understand.
But what we do know is that if you convince yourself that you can get better or your pain levels are reduced, then they have an amazing way of reducing.
Your brain literally improves your symptoms, which is a therapeutic effect – even if it might be considered by some to be unintended.
The effect of a placebo is really important to understand for a number of reasons
- Obviously the efficacy of drugs needs to separated from the mental benefits
- It teaches and proves (beyond doubt) the power of the brain and positive thinking in actually healing your own body and achieving pain relief.
The Dark Side Of Placebo.
Of course we have talked at length about the benefits of placebo, but the reverse can also be true – if a patient is dreading taking a medication they may experience side effects.
These side effects may be very real even if the pill is a sugar pill or the injection is just a plain saline solution that would do nothing.
Effectively if you work hard enough to convince yourself that taking medication will give you side effects such as nausea or sickness, then you can be fairly sure your brain will oblige. You will give yourself side effects.
Thankfully, because most people overwhelmingly believe that medicine will make them feel better, the outcome is generally positive.
When is a placebo not a placebo?
One of the really interesting bits of research by Kam-Hansen et al actually showed that even when patients were told they were taking a placebo, there was still some ‘bounce’ in positive effects.
The improvement was not as great as when told it was the active drug and even less than when it WAS the active drug, but this raises some very interesting points.
Clearly some people, even though they were told they were taking an empty pill, still mentally associated the process of swallowing a pill with an improvement in their health.
And once again – they expected it and their brain delivered it.
The Relevance Of A placebo And Pain Relief
Unfortunately, it is still not known why a placebo is effective. It has been proven time and time again to the point that no drug could realistically get a pharmaceutical licence today without being compared in a blind study with a placebo.
But the relevance of placebo for pain pain relief goes even further.
It actually validates the underlying concept of so many new ‘mindful’ techniques today. Each one relies on the concept that a changed mind can actually physically change a reality.
And as Luana Colloca commented in a review of numerous studies on the effect of placebo and pain relief, for The International Review Of Neurobiology,
“Importantly, when a person expects and experiences a placebo analgesic effect, cognitive and emotional circuitries are activated with experience of pain reduction and improvements in other symptoms”.
In other words, convince your brain you feel better and it will make sure you do.
The Final Word –
The placebo effect has a curious timeline, because in it’s infancy it was more of a pest to scientists and doctors desperate to find new solutions to problems.
They were dogged by an irritating concept that their new creations were not as effective as the clinical test suggested they were.
Eventually, placebo’s became accepted without anyone really understanding why they did what they seemed to. This meant research into the concept of placebo and pain relief (or any other effect for the matter) was rather sporadic and lacking any systematic framework
Even as late as 2009, Miller et al were trying to agree a framework for organising the vast amount of data on placebos and squeezing it in to some sort of theory about the exact mental processes involved.
However, although the exact mechanisms in the brain that trigger a placebo effect are not well understood, we do know that a placebo is a real entity that has a very real effect on pain.
We also know that this now established ‘fact’ has far reaching effects for the many ‘mindful’ techniques that have been claiming to be effective for the same reasons.
Ironically, many of the mindful techniques acknowledge that if you do not believe and truly endorse the principles taught then just carrying out any required actions will not generate the desired result.
This fits precisely with the placebo concept.
And as we know – placebo and pain relief are a very real entity.
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1. Slavenka Kam-Hansen, Moshe Jakubowski, John M. Kelley, Irving Kirsch, David C. Hoaglin, Ted J. Kaptchuk, and Rami Burstein (Jan 2014). Labeling of Medication and Placebo Alters the Outcome of Episodic Migraine Attacks. Science Translational Medicine
2. Luana Colloca. (May 2018). The Fascinating Mechanisms and Implications of the Placebo Effect. International Review of Neurobiology
3. Franklin G. Miller, Ph.D., Luana Colloca, M.D., Ph.D., and Ted J. Kaptchuk. (Autumn 2009). The placebo effect: illness and interpersonal healing. Perspectives in Biology and Medicine.
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