BLOCKING PAIN. Part V. The power of placebo

July 23 2010

How many times have you heard of special treatments on the radio and TV that promise miracles for your back pain or other pains? Actually, you may know people who have tried them and swear by them, despite the fact there are no scientific studies whatsoever that support such great effects. I have indeed seen hundreds of patients who have tried them, and who initially experienced a “remarkable improvement”, before the treatments stopped working.

These people experience the power of placebo. A placebo is defined as “an ineffective treatment believed to be effective”. The placebo effect represents a change in the patient’s illness or condition that is due to the symbolic significance of the treatment rather than the actual effect of a drug or a therapy. As long as the patient believes that a given treatment is “real”, no matter how ineffective or even bad it is, he/she will experience a positive effect.

We develop placebo responses with all kinds of treatments (medications, injections, surgery, creams and lotions, manual and other therapies and the list goes on). Ineffective treatments acting as placebos can relieve our pain, abnormal posture, wheezing and even symptoms of cold, fatigue, muscle aches, heart aches, anxiety etc. Scientific studies have shown that placebos have an impressive success rate that can be as high as 70 per cent! One of the best examples of the placebo effect relates to fake surgeries.

Fifty years ago, a popular surgery for relief of heart pain (angina) included opening up the chest and tying a small artery. This surgery resulted in dramatic relief of pain. Years later, some daring surgeons just opened up and closed the chest (even though the patients believed they received the special type of surgery we talk about).And, guess what: Similar numbers of patients experienced significant pain relief!

Today, no drug is approved unless it has gone through extensive studies, with both patients and researchers “blinded”, which means that neither knows if they receive the real drug or a fake one. As for surgeries, a more recent example relates to knee arthroscopy, a surgical procedure during which the orthopedic surgeon inserts a little tube inside the knee to “wash out” frail cartilage and clean up the joint. When a group of surgeons just opened up and closed their knee, many patients experienced significant improvement, since they believed they received the “real stuff”.

This does not mean, of course, the real procedure does not work. I had one myself for a badly damaged knee. When it “locked” (meaning that my knee suddenly got stuck in a bent position due to a chunk of trapped cartilage within the joint), I had emergency arthroscopic surgery and it definitely unlocked my knee. However, most of the surgical procedures used today, have been accepted as useful without similar comparisons for placebo effect.

But why do placebos work? Placebo effects are brought on by the interaction of the patient and the care giver within a certain environment. From the patient’s side, his or her beliefs and expectations, such as belief the treatment works, willingness to follow the treatment, a desire to get better, as well as levels of anxiety one may experience, are all very important. A friendly, warm, caring caregiver or health care professional, who strongly recommends the treatment, is another important ingredient of the placebo effect. Caregivers with prestige and reputation score even more. So does the appearance and reputation of the clinic or the hospital, as well as the cost and the look of the treatment. For example, red capsules are more effective than yellow or white ones, injections are more effective than pills and treatments that cost a lot bring better results than “cheap” treatments!