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February 18, 2010
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Would you feel better if, besides giving you a pill, your doctor also explained some potential benefits?
It’s quite likely, according to research from placebo effect studies from the past couple of decades. But an international group of researchers, led by Damien Finniss of the University of Sydney Pain Management and Research Institute in Australia, wanted to take a closer look at just how such an approach affects patients—and doctors who might make use of it.
"The placebo effect is a genuine psychobiological event attributable to the overall therapeutic context," the researchers explained in their review article published online February 18 in The Lancet. In other words, the effect is real but heavily dependent not just on the existence of possible treatment, but perhaps even more so on the environment in which it is administered.
Several types of placebo effects have been identified—from the psychological (conditioning and expectation) to the neurobiological (opioid release and changes in metabolic activity in the brain). But few studies have charted precisely how the clinical context of a placebo or treatment administration changes its effect.
Some studies have shown the effect of "nocebos," which patients are told their treatments might increase discomfort. Others have shown that receiving acupuncture, whether it is real, faked (with retracting needles) or done incorrectly, can better relieve back pain than traditional treatments. But the ethical slope is a slippery one, the researchers conceded, often making further research difficult without ample deception or withholding real treatment from people who need it.
In trials that give drugs to both groups, researchers can study the placebo effect in the way treatment is administered. Some studies have shown that if a drug is injected by a medical practitioner, patients respond better than if it is given at an unannounced time via computer-programmed injections. "The hidden administration removes the psychosocial context of treatment," the authors noted, decreasing patient expectation of relief. And it is hardly a nuanced difference: For example, in a postoperative pain study published in 2001, patients who were given painkillers via a random computer-programmed injection needed a 50 percent larger dose than those who had a person give them the injection.
But clinical trials do not control for many of these aspects of the placebo effect, the review authors argued, and few studies contain a non-treatment group or a group that experiences different clinical handling for comparison with the standard treatment and placebo groups.
Even more worrisome, they reported, with all of the data about the power of the placebo effect now widely recognized, some doctors might be blurring ethical lines by employing it to treat patients without full disclosure. "Routine conscious attempts to identify and exploit features of the clinical encounter to augment placebo effects represent ethical means of applying the understanding of placebo mechanisms to improve clinical outcomes," Finniss and his colleagues noted. But at what point can this treatment tool become deceptive?
Though they might not be sending their patients home with sugar pills, "clinicians often prescribe various active treatments with the main intent of promoting a placebo response," they wrote. Better disclosure might be the solution, they note, but if patients are given a placebo with full disclosure of its inertness—as well as its possible benefits—will it still work as well? The researchers prescribe more clinical research.
Image courtesy of Wikimedia Commons/Ragesoss
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"Others have shown that receiving acupuncture, whether it is real, faked (with retracting needles) or done incorrectly, can better relieve back pain than traditional treatments. " This quote from the above article is misleading and erroneous. There is no random controlled trail/s which substantiate the claim that fake acupuncture or acupuncture done incorrectly can better releive back pain than traditional acupuncture. This just adds to the public confusion regarding traditional acupuncture.
Link to thismisuse? If it works it is worth it isn’t it? Needs to be calculated into clinical studies but …
Link to thisTalk about picking a good apple out of a barrel of rotten ones… The author gave an unnessary, and unneeded, bad rap to acupuncture. Did Harmon do that because acupuncture has no adverse side affects and works when conventional medicine cannot and does not? Or did she use acupuncture as an example, because of womens’ care giving abilities, makes the greatest majority of them more prone to be hypercondreacts and that renders most medicine and acupuncture ineffective.
Link to thisZheng,
Link to thisI think that you have somewhat misunderstood the quotation about placebo acupuncture. Real, fake or incorrectly done acupuncture is described as sometimes being superior to "traditional" treatment. In American culture, "traditional treatment" is medication and surgery.
Acupuncture, like all clinical treatments, also has a placebo effect as just one component of it’s effect. Acupuncturists could take advantage of this by realizing that the manner in which they provide their treatment can either reinforce or detract from its effect.
No trials on acupuncture & back pain? I haven’t found the study itself, but did find this: http://godknowswhat.wordpress.com/2009/05/14/insane-reporting-on-acupuncture-trials/
And if not back pain, how about knee pain?
http://cre.sagepub.com/cgi/content/abstract/21/8/719
Seems to me that given there’s no physical explanation for acupuncture working other than ancient speculation on a par with the west’s old discredited "bodily humors", but much established evidence for the placebo effect, acupuncture is almost certainly pure placebo, and the differences between its effectiveness and that of conventional treatment would likely be erased by improvements in the manner of administration of conventional treatments as suggested in the article.
Link to thisJust a quick look for RCTs involving acupuncture:
A controlled trial of placebo versus real acupuncture.
Goddard G – J Pain – 01-APR-2005; 6(4): 237-42
Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain.
Lee SW – Am J Med – 01-JAN-2008; 121(1): 79.e1-7
Efficacy of acupuncture for the prophylaxis of migraine: a multicentre randomised controlled clinical trial.
Diener HC – Lancet Neurol – 01-APR-2006; 5(4): 310-6
Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: results of a randomized sham-controlled trial.
Link to thisWayne PM – J Pediatr Adolesc Gynecol – 01-OCT-2008; 21(5): 247-57
Knowing deceit in the administration of medical care because the administrator knows better is not an ethical slippery slope — it is a criminal act.
Link to thisKnowing deceit in the administration of medical care because the administrator `knows better’ is not an `ethical slippery slope’ — it is a criminal act.
Link to thisThere is a danger in bioethics of being so concerned about the patient’s rights to know everything about their treatment that the best possible outcomes for the patient are ignored. Placebo response is a very real phenomenon, and is an important contributor to the efficacy of any therapy. This is true even in cancer therapy. So, if one could improve outcomes in cancer by telling patients a sugar pill is actually an effective medication, would it be ethical? In conventional terms it is not, yet the undeniable benefits of placebo response are therefore denied the patient on ethical principle. Which is in effect doing the patient harm and is therefore unethical. Clearly, we need to better understand why placebo response occurs and how it works in order to extricate ourselves from this ethical Catch-22.
Link to thisThank you for sharing ideas about The placebo effect. Before we take the medicine it’s important to consult first our doctor to make sure that we taking good med properly.
http://feelbettercenter.com/
Link to thisPlacebo is powerful, so why not use it?
And, it doesn’t need to take the form of a pill and you don’t even have to "lie" to a patient.
Here is the secret: Understanding that we have two competing brains. One is the primitive brain (the threat center that watches for "things" that are bad) and the "higher awareness" part of your brain. You just have to fake-out the primitive brain with your higher awareness.
Why does this matter?
Let me explain. Because… although it is not necessarily the definition of "placebo," but it is precisely how the placebo effects works. The key for pain intensity (and other forms of suffering, like the common cold) is your sensitivity level. Or, in other words, how stressed-out your cells are in the region of complaint and along the pathway to the brain. Stress will in turn cause your immune system to stop working to heal your condition.
Therefore, if you neutralize your pain sensitivity then you can dramatically reduce your pain rating and also promote recovery via natural self-healing.
We are having more success than ever using these principles at this Provo physical therapy clinic. For more information and details, check this website:
http://advancedspineandpainsolutions.com
Link to this