How Does The Placebo Effect Work?

Chronic pain is a serious issue and is a constant concern for those who suffer from it. There are many treatments for pain depending on the source. These can include medications, therapies, and even surgery. Effectiveness often depends on the severity of the condition and which treatment method is employed. However, there is also a fascinating phenomenon known as the placebo effect that plays an important role in the recovery process for all patients. And, the placebo effect does not necessarily depend on conventional treatment factors.

What is the placebo effect?

The placebo effect provides a telling example of just how powerful perception is when talking about physical health. In short, the placebo effect is when a “fake” treatment is provided to a patient. The patient, however, believes it is a medically viable treatment. The placebo effect occurs when the patient actually experiences improvement in their condition from this sham treatment. It is believed that the expectation of relief or pain can be strong enough to provoke mental and physical changes in the body. The stronger the belief, the more powerful the outcome has been shown to be.

There is also the opposite of the placebo effect, which is known as the nocebo effect. This induces side effects on the recipient. This effect is still being studied, but it is believed that the increase in perceptions, like anxiety, may be a major source of side effects, such as nausea and an increased perception of pain.

The placebo effect in research

The placebo effect can be seen mostly readily when using sugar pills, as they are a common replacement for pharmaceutical drugs in clinical trials. This is done so that new medications can be evaluated objectively. Sugar pills allow us to see if new drugs are actually providing a positive effect or if the placebo effect is doing all the work.

Some studies have shown that patients will still improve markedly under a placebo treatment compared to those who receive no treatment at all. And, when given two placebo drugs, patients will experience better results if they believe the medication they are taking is more costly than the other option. Studies also show that patients who are told about the side effects on a placebo treatment have a higher chance of experiencing those side effects.

A study conducted by Irving Kirsch, Ph.D and Guy Sapirstein, Ph.D explored the efficacy of antidepressant drugs when compared with placebo medications. According to the research findings:

The placebo response was constant across different types of medication (75%), and the correlation between placebo effect and drug effect was .90.”

This tells us that a huge part of a drug’s effectiveness (75%) can be attributed to the belief that it will provide relief. Of that 75%, it was shown that 50% was due directly to the placebo effect. The other 25% was due to other factors like physician attention and how the drug was administered. The study showed that only 25% of a drug’s effectiveness was attributed to the actual ingredients aimed to treat the condition, in this case depression.

Does the placebo effect influence pain management?

It should be noted that the placebo effect isn’t thought to be an entirely imaginary improvement. Oftentimes, the body does respond with physical changes when placebo treatments are used. This can take many forms such as an increase in pulse rate, blood pressure, and even the production of endorphins, a naturally made painkiller.

This can be noted when comparing different conditions. Research has shown that the placebo effect is quite powerful when it comes to pain, however it provides very little, if any, benefit to treat diseases such as cancer. A study in the Journal of the National Cancer Institute showed that mood and the perception of pain was improved, but it did not contribute to a prolonged life span for patients.

The placebo effect has yet to be conclusively proven as a viable medical treatment for any condition. But, there have been quite a few research studies that demonstrates how it can be an important tool for pain relief, even if it is not yet well understood. In essence, the placebo effect triggers something in the body’s pain control centers that can reduce the overall sensation of pain. One study, using functional magnetic resonance imaging (fMRI), even showed a decrease in brain activity in pain sensitive brain regions such as the thalamus, insula, and anterior cingulate corte.

The placebo effect and future pain management

Overall, it is quite likely that the placebo effect can be used to help manage pain. Even when patients know they are taking a placebo, positive effects have still been observed.

But consider this: is it ethical for physicians and medical professional to use the placebo effect to treat pain as it requires deception for maximum effect?

This is currently a hot topic as more and more evidence shows that placebos can be more effective than no treatment at all. In a recent survey of 679 responding physicians, about half said they had prescribed a placebo treatment on a regular basis. 62% believed it was an ethical practice, however, few used completely inert compounds, such as saline or sugar pills. The majority of respondents prescribed over-the-counter analgesics and vitamins instead. On top of that, most doctors described the treatments as a potentially beneficial medicine or treatment not typically used for the patient’s condition.

As it stands, it seems most physicians know that psychology plays an important part in the healing process. Many times patients can feel better just from the act of taking medication, even if it is the OTC kind. If the proper guidelines and procedures can be established, such as those suggested by a study in the Journal of Medical Ethics, it is possible that placebos can be fully utilized in the medical industry. It could also be used alongside other lifestyle and treatment methods to create a truly comprehensive treatment plan. This has the potential of greatly reducing cost as well as side effects that are currently present with many of today’s care options.

Have you ever found out that you experienced the placebo effect? What are your thoughts on doctors using it for treatment?