JUST A SPOONFUL OF SUGAR HELPS THE CHRONIC PAIN GO DOWN …
▶ Body responds to placebos even when we know that’s what they are, Robert Matthews writes
There’s rarely any good news about the treatment of chronic pain, despite it being the most common health-related disability in the UAE. But now a radical approach is showing promise in providing long-lasting relief with no side-effects – and it costs virtually nothing.
It is also highly controversial and more than a little bizarre. It requires patients to take sugar tablets.
Doctors have long known that it is possible to get genuine benefit from taking some inert substance instead of a genuine medicine. But the power of the so-called placebo effect – from the Latin for “I shall please” – is also widely viewed with suspicion.
The reason is that it only works if patients are tricked into believing they are taking a proven remedy – an approach many doctors regard as unethical, whatever the benefits.
But now researchers are discovering placebos can work, even when patients are told what they’re getting.
This perplexing discovery is sparking a rethink on the use of placebos in medicine – and one with special importance for those in the UAE.
Some of the ailments likely to respond to placebo treatment are now being treated using potentially addictive compounds subject to tight regulation – so tight that patients can be under-medicated.
But with no active ingredient, placebos have no such drawbacks. All of which raises the question: how can they possibly work?
Sceptical doctors have long dismissed any benefit from placebos as being “all in the mind”, but it is increasingly clear this is not the knockout argument it may seem.
Over the years, scientists have found that patients with chronic pain who are given placebos show changes in the same areas of their brain as those affected by powerful morphine-like painkillers. Similar effects have been found for patients with depression.
The findings suggest that placebos somehow trigger the body’s own systems to deal with ailments.
A recent review of such “open-label” placebo treatments found evidence for their effectiveness with a wide range of disorders, from Attention Deficit Hyperactivity Disorder to Irritable Bowel Syndrome.
Some of the most impressive results were found for lower back pain, one of the most common medical conditions in the UAE.
Researchers found that patients told to take two placebo pills twice a day for three weeks actually did better than those given standard treatment for chronic back pain.
While the studies showed the effectiveness of open-label treatment, the explanation remains elusive. But they are in line with research suggesting that just taking the placebos, knowingly or not, may not be enough.
As the Russian physiologist Ivan Pavlov famously showed in his experiments with dogs in the 1890s, real physical responses can be triggered in living organisms by “conditioning” them first.
Pavlov made dogs salivate by simply ringing a bell, after conditioning them to link the sound with being fed.
In the case of human patients, the conditioning involves having patients link taking the placebo with the possibility of feeling better.
Research has shown that the “bedside manner” of doctors also plays a role in the success of such conditioning.
In one UK study, a group of patients were given a clear, firm diagnosis of their disorder and told they would soon be better, with some then left untreated.
Meanwhile, another group received a vague diagnosis and no assurance about recovery, regardless of whether they received treatment or not.
The results were spectacular. Almost two thirds of those patients given a positive consultation became better, compared to 39 per cent of those who received the downbeat assessment.
Whether they were actually treated or not made no difference at all.
In other words, the attitude of the doctors had far more effect on how the patients fared than the medicine they were given.
The way the treatment is given also seems to matter, with injections typically giving better results than pills. But even the colour of the pills can have an effect.
In one of the most celebrated studies into the placebo effect, carried out in the early 1970s, patients given sedatives were more than twice as likely to feel drowsy as those given a powerful stimulant.
This is no surprise, except that both sets of patients had been given the same harmless compound.
The only difference was that the sedative was a relaxing shade of blue, while the stimulant came in a perky shade of pink.
The discovery that placebos can work even when patients know what they’re getting is the latest twist in one of the most controversial issues in medicine.
Clearly more research is needed if treatment with placebos is to win over the sceptics. But some caveats are already clear.
First, the technique is no panacea. Decades of research have shown that while it can bring relief from some conditions such as chronic pain, migraine and depression, it is no cure – and is useless against diseases such as cancer and Alzheimer’s.
Nor will it work for everyone. Research published earlier this month in Nature Communications showed that patients with certain psychological traits, such as emotional awareness and openness to experience, are more likely to respond than others.
The researchers also found that the architecture of the brain may play a role.
But there is one group of people who will not be remotely surprised by any of this: practitioners of “alternative medicine”.
They have always insisted that techniques ranging from acupuncture to homeopathy can bring genuine relief to certain conditions.
Such claims have long been dismissed as unfounded, unscientific and possibly dangerous.
At the very least, the latest discoveries about the placebo effect suggest we still have much to learn about the body’s ability to treat itself.
Researchers found that patients who took two placebo pills twice a day did better than those given standard treatment for chronic back pain
Robert Matthews is Visiting Professor of Science at Aston University, Birmingham, UK