A Placebo Treatment for Pain - The New York Times - 0 views
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This phenomenon — in which someone feels better after receiving fake treatment — was once dismissed as an illusion. People who are ill often improve regardless of the treatment they receive. But neuroscientists are discovering that in some conditions, including pain, placebos create biological effects similar to those caused by drugs.
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Taking a placebo painkiller dampens activity in pain-related areas of the brain and spinal cord, and triggers the release of endorphins, the natural pain-relieving chemicals that opioid drugs are designed to mimic. Even when we take a real painkiller, a big chunk of its effect is delivered not by any direct chemical action, but by our expectation that the drug will work. Studies show that widely used painkillers like morphine, buprenorphine and tramadol are markedly less effective if we don’t know we’re taking them.
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Placebo effects in pain are so large, in fact, that drug manufacturers are finding it hard to beat them. Finding ways to minimize placebo effects in trials, for example by screening out those who are most susceptible, is now a big focus for research. But what if instead we seek to harness these effects? Placebos might ruin drug trials, but they also show us a new approach to treating pain.
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It is unethical to deceive patients by prescribing fake treatments, of course. But there is evidence that people with some conditions benefit even if they know they are taking placebos. In a 2014 study that followed 459 migraine attacks in 66 patients, honestly labeled placebos provided significantly more pain relief than no treatment, and were nearly half as effective as the painkiller Maxalt.
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With placebo responses in pain so high — and the risks of drugs so severe — why not prescribe a course of “honest” placebos for those who wish to try it, before proceeding, if necessary, to an active drug?
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Another option is to employ alternative therapies, which through placebo responses can benefit patients even when there is no physical mode of action.
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a key ingredient is expectation: The greater our belief that a treatment will work, the better we’ll respond.
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Individual attitudes and experiences are important, as are cultural factors. Placebo effects are getting stronger in the United States, for example, though not elsewhere.
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Likely explanations include a growing cultural belief in the effectiveness of painkillers — a result of direct-to-consumer advertising (illegal in most other countries) and perhaps the fact that so many Americans have taken these drugs in the past.
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Trials show, for example, that strengthening patients’ positive expectations and reducing their anxiety during a variety of procedures, including minimally invasive surgery, while still being honest, can reduce the dose of painkillers required and cut complications.
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Placebo studies also reveal the value of social interaction as a treatment for pain. Harvard researchers studied patients in pain from irritable bowel syndrome and found that 44 percent of those given sham acupuncture had adequate relief from their symptoms. If the person who performed the acupuncture was extra supportive and empathetic, however, that figure jumped to 62 percent.
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Placebos tell us that pain is a complex mix of biological, psychological and social factors. We need to develop better drugs to treat it, but let’s also take more seriously the idea of relieving pain without them.