The placebo effect, is it a good thing or a bad thing? Does placebo treatment have any place in medicine or should it always be avoided? The term placebo refers to a substance or treatment with no active therapeutic value, such as an inert pill, many manual therapy treatments, or sham medical procedures. But is it really just a worthless sugar pill? In this blog post, we will explore the concept of the placebo and its potential uses in treating chronic pain, its implications with informed consent, and alternative explanations for positive responses.
What is Placebo?
The placebo is not the inert substance alone, but rather its administration within a set of sensory and social stimuli that tell the patient that a beneficial treatment is being given. But what exactly does that mean? Is it simply a fake treatment that tricks our minds into feeling better? Well, it turns out that the placebo effect is much more complex than that.
At its core, a placebo is a demonstration of the power of context and our minds. It highlights the intricate relationship between our thoughts, beliefs, and physical well-being. When we believe that a treatment will make us better, our brains release natural chemicals that can actually improve our symptoms. This supports the idea that our thoughts and expectations have a profound impact on our physical experiences.
The placebo effect has been studied extensively in medical research, and it has been shown to have both positive and negative effects. In some cases, placebos have been found to produce significant improvements in various health conditions, including chronic pain. Patients who unknowingly receive an inert treatment often report a reduction in pain and an improvement in their overall well-being. This suggests that the power of suggestion and belief can have a tangible effect on our bodies.
However, it’s important to note that treatments involving a placebo effect are not a cure-all. While it can provide temporary relief, it does not address the underlying cause of a medical condition. They can create room in the cup, do nothing, or cause harm when uninformed. They can even cause dependence on treatments that aren’t helping you and may be hindering you. Informed consent becomes a very important aspect of treatment at that point.
But have you heard of Nocibo?
Placebo is a treatment that provides positive”ish” results. The Nocebo effect is the other side of the coin. The nocebo effect occurs when a person experiences negative side effects or worsening symptoms simply because they believe a treatment or intervention will have a negative effect on them.
This also applies to a diagnosis. When your doctor tells you it’s the worst arthritis they have ever seen. There is their is nothing more they can do. Telling you that you will have to live with pain forever. These are all statements that can make our pain worse. They aren’t inert. They are harmful. Don’t underestimate the power of words.
This is the power of the Nocibo effect. Our beliefs and expectations can shape our physical experiences, and when it comes to chronic pain, this can be detrimental. The fear and anxiety surrounding a treatment can actually amplify pain signals in the brain, making the pain more intense. The expectation of failure or continued suffering is part of the puzzle of pain. It was a huge part of mine. The information I was given about my SI Joint paved the way for my failure to resolve my pain because of the beliefs and behaviors it created.
Understanding the nocebo effect is crucial, as healthcare providers must be mindful of the potential negative impact of their words and explanations. It is important for providers to emphasize the potential benefits of a treatment while addressing any concerns or potential side effects. By fostering a positive and supportive environment, healthcare providers can help mitigate the nocebo effect and enhance patient outcomes.
The Power of Expectation
Our expectations play a powerful role in treatment outcomes. Our minds are incredibly influential in shaping our physical experiences, and our beliefs can have a profound impact on our well-being. The power of expectation is at the heart of the placebo effect. Did you know red pills work better than any other color? That bigger pills are better than smaller ones. Or that sham surgery can produce the same results as the actual surgery?!
For example, let’s say you’re suffering from chronic back pain. You visit a doctor who tells you about a new treatment that has shown promising results. They explain how it works and what you can expect. As you listen, your brain begins to form expectations about the treatment’s effectiveness. These expectations trigger the release of endorphins, our body’s natural painkillers. Even before you start the actual treatment, you may start to feel some relief from your pain.
But here’s where it gets interesting: the power of expectation doesn’t just stop at pain relief. It can also influence other aspects of our health. For example, studies have shown that patients who receive a placebo treatment for depression can experience a decrease in their depressive symptoms. Their expectation of improvement actually leads to improvement.
It is not limited to physical ailments either. It can also affect our cognitive abilities. In a study conducted at Harvard University, researchers gave participants a sugar pill and told them it was a cognitive-enhancing drug. The participants who believed they had taken the real drug performed better on cognitive tests compared to those who knew they had taken a placebo.
Our expectations can even shape our perception of side effects. If we believe a treatment will cause certain side effects, we are more likely to experience those side effects, even if the treatment itself is inert. This demonstrates how our thoughts and beliefs can directly influence our physical experiences.
Positive and Negative Effects of Placebo
Let’s face it. When you really dig into the research, very few treatments for chronic pain work the way we are told. We know that for low back pain movement is the most effective treatment and everything else is equal to the placebo groups.
Many of my clients find this frustrating. May I offer, it doesn’t have to be. Everyone has a treatment that they favor. For me, I really appreciated strain-counterstrain. My first physical therapist was very caring, the only person in 4 months to help me, and was very confident that she knew how to help. This was the intervention she used. It’s nothing special. It’s not the key. Her hope, confidence, kindness – that was the key.
This provided me hope and a belief I could get better. It did help, for a time. Even though the treatment itself wasn’t any better than doing nothing, her words, kindness, and gentleness were powerful. So, if we toss the faulty explanations aside and understand that feeling good and having hope IS the treatment. If we aren’t going into debt and stressing about appointments and “doing things correctly” then those inert treatments are okay! This is my opinion. But in a world where so many of the things we are offered are pointless – we go with what feels good.
I am all in favor of Dumbo’s magic feather to help us navigate chronic pain. If we need a specific treatment to help empty our cups so we can move towards larger lives. Well, do it. Understand why you are doing what you are doing and consider if you need to continue. You are the one in control.
The Negative
I want to be clear that choosing to continue interventions that have no clinical value also has negative side effects, especially if we are uninformed! While I am ever thankful for my first PT. There were some negative aspects as well. It was horribly expensive. I had to drive 2.5 hours every week to see her. At the time, I believed that this was the only treatment that would help my pain. I became frantic when I couldn’t find another therapist that used it. It was stressful and made me lose hope the next time my pain flared and wouldn’t stop.
When we are tied and married to our placebos that really hinders us from healing. We have to be able to fly without the feather too. ( See the Dumbo reference.) Then it turns from something good and becomes something not so good. Use them wisely.
Exploring Placebo’s Effects on the Brain
How exactly does the placebo/ nocibo effect impact our brains? In this section, we will explore some of the theories of placebo on the brain and uncover some of the possible underlying mechanisms at play.
Neuroscientists have used various imaging techniques, such as functional magnetic resonance imaging (fMRI), to investigate the neural changes that occur during placebo responses. These studies have provided valuable insights into the brain regions involved in the placebo effect.
One key finding is that it activates the brain’s reward and pain-modulating systems. When we believe that a treatment will work, our brain’s reward system releases neurotransmitters like dopamine, and endogenous opiates, which can produce feelings of pleasure and well-being. This activation of the reward system contributes to the positive experiences reported by individuals who receive a placebo treatment.
Furthermore, placebo responses have been linked to changes in the brain’s prefrontal cortex, which is involved in cognitive processes like decision-making and attention. This suggests that our beliefs and expectations play a role in regulating our attention and focus, influencing our perception of symptoms and overall well-being.
Interestingly, recent studies have revealed that the placebo effect is not solely a result of conscious processes. Research using brain imaging techniques has shown that placebo responses can occur even when individuals are unaware that they are receiving a placebo. This suggests that unconscious processes in the brain may contribute to the placebo effect, highlighting the complex nature of this phenomenon.
While our understanding of the neurobiology of placebo is still evolving, these studies demonstrate the profound impact that our thoughts and beliefs can have on our brains and physical experiences. We simply can not underestimate this aspect of medicine.
The Contextual Effect
While the placebo effect is often attributed to the power of suggestion and belief, there are other factors at play. One such explanation is the contextual effect. This theory suggests that the context in which a treatment is administered can significantly impact its effectiveness.
Think about it. When we visit a doctor’s office or a hospital, we are surrounded by symbols and cues that signal healing and recovery. The white lab coat, the stethoscope, the clean and sterile environment – all of these factors contribute to our expectations of feeling better. These contextual factors can shape our beliefs and amplify the placebo effect.
Studies have shown that the physical setting and the demeanor of healthcare providers can influence the effectiveness of a treatment. For example, research has found that patients who receive treatment from a caring and empathetic doctor tend to experience better outcomes than those who are treated by a cold and distant doctor.
The rituals and routines associated with medical care also contribute to the contextual effect. The act of taking a pill, undergoing a medical procedure, or receiving an injection can elicit a sense of hope and belief in the treatment. These rituals provide a sense of structure and purpose, reinforcing our expectations of healing and recovery. This does not mean that the treatment itself is insignificant or ineffective. Rather that the context in which it is delivered plays a crucial role in its overall effectiveness.
It’s important to note that the contextual effect does not diminish the value of evidence-based medicine. Rather, it highlights the complex interplay between our minds, bodies, and the environment in which we receive healthcare. We must understand it’s both and. Evidence and context.
The Importance of Informed Consent
Informed consent is the process by which healthcare providers communicate relevant information to patients so that they can make an informed decision about their medical care. This includes discussing the risks, benefits, alternatives, and potential outcomes of a treatment or procedure. It also includes an explanation of what a treatment is supposed to do.
When it comes to the use of placebos, informed consent becomes even more significant. If a healthcare provider is considering using a placebo treatment, they must clearly explain to the patient what a placebo is, why they want to use it, and the evidence surrounding it. This allows patients to understand that they may be receiving a treatment with no active therapeutic value. This helps them weigh the potential benefits and risks.
When it comes to the use of placebos, transparency, and honesty, are paramount to ensure the well-being and autonomy of patients. Physical Therapy treatments are full of placebos, and unfortunately, most clinicians are unaware of that. That means you, as the “consumer” need to be educated and informed.
Be assured if anyone is telling you they are stretching your fascia, realigning bones with their hands, or things like that, the treatment may be helpful. However, that does not mean they work the way you have been told. In fact, they do not. But that’s a different blog post.
Conclusion
In summary, the placebo effect can temporarily help empty your cup. This can reduce pain and create more space for healing. The words spoken around our treatments and conditions mean just as much as the treatments we select. They can also cause harm. Transparency, honesty, and a comprehensive approach to care are essential in ensuring the well-being of people experiencing chronic pain. By balancing the use of the placebo effect with necessary medical interventions, you can improve your pain without adding to false beliefs!
