Updated: Feb 26
Placebo is the positive result to a treatment that you believe will help you despite it having little therapeutic benefit.
Placebo is NOT an imaginary effect, there are physical changes that can be observed and measured.
Nocebo is a negative result to a treatment that you believe will do no good or even feel may harm you. Despite the fact that it can't.
Almost all treatments, including surgery, have an element of the placebo effect to them. Some will have a very small percentage and some a much larger percentage.
Placebos seem to have the greatest power over symptoms that have a degree of "psychological"/cognitive input i.e your brain has a role. That is why the placebo can have a very potent effect on the treatment of pain.
I have a friend who at frequent times comes up with what seems to be a dismissive statement of " it's just a placebo effect though" when the topics of treatments for pain related problems come up . So instead of trying to convince him otherwise, which has an inevitable futility to it, i take another sip of my beer and a little bit inside of me cries out in frustration.
Well no more its time we clear this up and have a look at this amazing capacity that our body has and its importance in pain relief. It's pretty awesome and very very clever. It's also a little more complex than just taking a sugar pill and hoping for the best.
Before we start i'll set the scene by getting a brief understanding of pain.
Pain is a symptom, its real and its impact varies greatly from being a nuisance to be being very limiting to our function.
Pain is a protective mechanism in the early stages of an injury to help protect us causing further damage.
Persistent pain or ongoing pain rarely provides a protective function. It is more likely to be an over sensitive or angry structure. Think of it as an alarm system that won't switch off.
Almost all aches and pains have a component that is driven from our brain. From bumping our elbow on the table to persistent back pain. This DOES NOT mean its "all in your head" but if you've got no brain then you've got no pain.
What the "placebo" effect does is it modulates, or if we're really lucky switches off, our overactive alarm system.
What is a placebo ?
Placebo is latin for " i will please".
It is a treatment that reduces symptoms only because the patient expects a benefit, not because the treatment itself has any effect. To expand on this i would add that a placebo is also a POSITIVE disproportionate response to an applied treatment.
It's fair to say that almost all treatments have a placebo effect attached to their effectiveness. So there is always a percentage of a placebo effect with every treatment we receive.
Interesting science fact #1
As an example of this a study was done looking at the effect of morphine on pain.
When morphine was given to a patient by a hidden robotic pump was shown to be 50% less effective in initial 2 than when administered by a person !
The opposite of the placebo is the nocebo.
It causes negative changes in symptoms (e.g. more pain and reduced function) when there is an expectation that an otherwise harmless stimulus will cause harm.
Interesting science fact #2
There have been studies that people who believe they are gluten intolerant get abdominal pain and symptoms consistent with intolerance. This is despite having no markers for it. In this case we could argue that gluten is the nocebo in this study.
In regards to pain if we believe a movement or activity will cause us more pain and we are fearful of it then chances are our symptoms can be made worse. This is despite the activity being perfectly safe e.g bending forwards.
What can a placebo do ?
Here is a list of placebo effects that have been studied:
Change in pain level.
Reduce muscle tension.
increase energy level.
improve the immune response.
lower heart rate, and glucose level.
They can even make you drunk!
If someone has a placebo response to a treatment then there are actual physical changes within that persons body. It's not all smoke and mirrors kidology by the brain.
What a placebo can't do
They are not substitutes for best evidence care or treatment. They will not cure heart disease, cancer, osteoporosis, asthma etc.
You should always follow your specialists / drs advice in best treatment.
Why is the placebo effect important ?
To be honest there are not many conditions that don't have some degree of this and it is why it can have a very potent effect on the treatment of pain.
So is it all in my head then ?
Your brain is not a separate entity to your body, research has shown they are connected and work really well together! You should think of your brain as the command centre that instructs the body what to do and how to behave.
The fascinating fact is that there are physical changes in the body that can be measured in response to placebo type treatments. Below are a few examples
Evidence of the placebo effect in surgery .Warning do not try this at home !
I want to focus on the placebo effect and pain but these examples help us understand that this phenomena has wide ranging effects on other systems.
Interesting science fact 3.
Research has shown evidence of placebo surgery positively changing in blood flow to the heart in angina sufferers. Read more here
Interesting science fact 4.
There has also been evidence that immune system markers are improved with a placebo based treatment. The interesting aspect to this is the immune system is not directly influenced by the brain !
How does the placebo effect work in the treatment of pain?
There's no simple answer to this but here are some of the elements that are in play:
Regions of the brain that are responsible for our own opioid production and release are more active in response to "placebo" based treatments for pain.
The placebo effect can be blocked in people with the drug naxalone which stops opioid production.
The Spinal cord:
The spinal cord has areas in it that are responsible for increased sensitivity following an injury.
Placebo based studies shown to switch down these areas so the perception of pain is reduced.
The placebo response is something we learn via cause and effect. When we take an active drug, we often feel better. This creates a memory we revisit when we take that drug again or if we take a placebo we think is the same medication.
Belief about treatments and how they are delivered.
The more positive we are about the effect of the treatment we are to receive then the better the effect it will have.
Also the environment and the person we receive the treatment in adds to the therapeutic effect. If we have a rapport and trust the person that is treating us, our response to treatment is better.
What does the placebo effect mean for me ?
The placebo effect plays a role in most traditional aspects of known medicine, therapy and even surgery. Sometimes it may only be a very small percentage of the treatments effect, sometimes it can be very significant, this is especially true with pain and conditions with a psychological overlay.
If you get benefit from a form of treatment does it really matter what the percentage is "placebo" and what is not ? In fact it may be very influential in the success of some treatments
What is important is that in the future neuro-scientists will be able to find out more about this effect so we can leverage it better in our favour.
Thanks for reading and if you want to know more check these links below.