If someone believes a form of treatment will relieve pain, it will do so far more effectively than if the belief is that the treatment cannot help.
Today’s posting is a brief skip through the potency and power of placebo – in a future posting I’ll discuss it’s opposite – the nocebo effect.
In truth all healing methods involve a degree of placebo (or nocebo) and in many instances it offers more benefit than active treatments. It is the hidden, powerful, ally of good therapeutic measures.
For example, in trials involving over 1000 people suffering from chronic pain, dummy medication reduced the levels of the pain by at least 50% of that achieved by any form of pain-killing drug, including aspirin and morphine.
The researchers, Melzack & Wall (1989) explain, ‘This shows clearly that the psychological context – particularly the physician’s and patient’s expectations – contains powerful therapeutic value in its own right in addition to the effect of the drug itself’.
• Placebos are far more effective against severe pain than mild pain.
• Placebos are more effective in people who are severely anxious and stressed than in people who are not, suggesting that the ‘anti-anxiety’ effect of placebos accounts for at least part of the reason for their usefulness.
• Placebos work best against headache-type pain (over 50% effectiveness).
• In about a third of all people, most pains are relieved by placebo.
• A placebo works more effectively if injected, rather than if taken by mouth.
• Placebos work more powerfully if accompanied by the suggestion that they are indeed powerful, and that they will rapidly produce results.
• Placebos which are in capsule or tablet form work better if two are taken rather than one.
• Large capsules work as placebos more effectively than do small ones.
• Red placebos are most effective of all in helping pain problems.
• Green placebos help anxiety best.
• Blue placebos are the most sedative and calming.
• Yellow placebos are best for depression and pink are the most stimulating.
• Placebos have been shown to be effective in a wide variety of conditions including anorexia, depression, skin diseases, diarrhea and palpitation.
• Placebo effects do not only occur when taking something by mouth or injection; for example, any form of treatment from manipulation to acupuncture to surgery carries with it a degree of placebo effect.
Recognition of the placebo effect allows us to realize the importance of the power of suggestion on all of us, with some people being more influenced than others.
It is important that we should not think that because a placebo ‘works’ in an individual that the person is not genuinely suffering pain or that the reported relief is false (Millenson 1995).
A person’s attitudes and emotions can be seen to be powerful aids (or hindrances) to recovery. The feelings of hope and expectation of improvement, coupled with a relationship with caring helpers, professional or otherwise, assist in recovery and coping.
An example of placebo potency is exemplified by a study by Price et al (2007) associated with brain activity and irritable bowel syndrome. They note that:
“Previous experiments found that placebos produced small decreases in neural activity of pain-related areas of the brain, yet decreases were only statistically significant after termination of stimuli and in proximity to when subjects rated them.
These changes could reflect report bias rather than analgesia. This functional magnetic resonance imaging (fMRI) study examined whether placebo analgesia is accompanied by reductions in neural activity in pain-related areas of the brain, during the time of stimulation. Brain activity of irritable bowel syndrome patients was measured in response to rectal distension by a balloon barostat. Large reductions in pain and in brain activation within pain-related regions (thalamus, somatosensory cortices, insula, and anterior cingulate cortex) occurred during the placebo condition. Results indicate that decreases in activity were related to placebo suggestion and a second factor (habituation/ attention/conditioning). Although many factors influence placebo analgesia, it is accompanied by reduction in pain processing within the brain in clinically relevant conditions.”
Appropriate education, patient focus, and a strong suggestion – say that self-regulation (homeostasis) will assist recovery, if appropriate lifestyle modifications are undertaken – for example if diet, sleep, breathing, posture and exercise are attended to – may assist not only in practical ways, but via the placebo effect as well.
For a deeper look at this topic see David Peters’ ‘Understanding the Placebo Effect in Complementary Medicine’ (Elsevier 2001)
Melzack R, Wall P 1989 Textbook of pain, 2nd edn. Churchill Livingstone, London
Millenson J 1995 Mind matters – psychological medicine in holistic practice. Eastland Press, Seattle
Price D et al 2007 Placebo analgesia is accompanied by large reductions in pain-related brain activity in irritable bowel syndrome patients Pain 127:63–72