The placebo effect for chronic pain relief is a fascinating topic. In fact, studies have shown we are capable of creating pain relief as powerful as opioids – if we believe that’s what we should be experiencing. Watch the video to find out more.
Naomi: So the question is how do, how does the placebo effect for chronic pain work? What is happening when someone takes a sugar pill or has an operation on a knee that sore and swollen and they don’t actually have the operation. They just have two little nicks from a scalpel, and general anaesthetic and afterwards they feel heaps better. What was going on there?
Jonathan: So this is so exciting. This is what’s called a psychobiological effect, or a NeuroMind reaction. What happens is something unconscious in the person’s mind turns on and causes changes in their body.
At the most basic level, this is called a conditioned response. If you go way back to Dr Ivan Pavlov who took a group of dogs. He measured how much saliva they’re made when they smelt food, and they made lots. He then rang a bell and when they heard it, they did nothing.
Then he put the two together. He rang the bell and at the same time they smelled the food, and they made saliva. And then he just rang the bell and they made saliva.
So what happened is when the dogs heard the bell, in their minds they expected food and that expectation turned on something in their body which is making saliva.
Naomi: This would normally be a totally unconscious reaction – something not under the direct control.
Jonathan: It’s not conscious at any stage. In other words, previously when they smelled the food tand they heard the bell, there was no saliva, but now a new connection had been made. This meant that the expectation in their mind turned something on in their body so that they made saliva.
If you have an expectation, which is exactly what you said in the beginning, this creates a placebo effect for chronic pain. If I’m a very nice doctor wearing a white coat, and I’m looking very authoritative and I give you a great big blue pill and I said “This will make you so much better,” and you take it, this creates an expectation and a belief.
You think “This guy knows what he’s talking about, I trust him.” As you do that, and as you then take the pill, you create an expectation which turns on a process in your body which is then going to start to make you better.
There’s been a whole series of studies to see how powerful and how precise this placebo effect for chronic pain is. In one group of studies what people have done is called conditioning, similar to when Pavlov rang his bell.
They set up person, who’s in pain. They give this person some morphine. At some stage, they stop the morphine and instead give them a pill that looks exactly and tastes exactly the same as morphine.
Let’s see what happens with this apparent continuation of treatment.
So you’re conditioned, you’re taking the morphine, it’s helping you, you’re feeling better, and then the morphine stopped, the pill changes, but it looks the same, so you don’t know it’s changed. You believe you’re still taking morphine.
What they found is there was very little to no change in pain relief between the morphine itself and the placebo pill. This means we have the ability in our bodies to relieve pain that as strong as morphine.
In fact, the way morphine works is it attaches to receptors in your body. Those receptors weren’t made for morphine. They were made in endorphins.
The reason the people in this study didn’t feel pain, was because they were on one of the strongest pain relieving systems in our body: endorphins.
Endorphins are what attach to the receptors opioids use and they make us feel better – with no side effect. They caused the pain to go down, and this effect was turned on by a powerful Placebo, by an expectation or belief.
What the researchers did next was fascinating. They gave the patients in the study a drug called Naloxone, which is a morphine antagonist or a endorphin and antagonist.
It gets to the receptor, attaches first, and locks it. In essence it blocks the effect of morphine. While the people were taking morphine, if you gave them Naloxone, the pain came back.
When they were no longer on morphine, but were taking the placebo, and they took Naloxone, the pain came back as well.
So it’s very clear that when the morphine’s stopped, people easily made enough endorphins to give themselves exactly the same pain relieving effect – because that’s what they expected and believed should be happening.
Any time a technique in the treatment of a patient can predictably change autonomic nervous system function, It truly is amazing.Reply