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A Fibromyalgia Doctor's Thoughts on the 'Placebo Effect'

  [ 32 votes ]   [ Discuss This Article ]
By Mark J. Pellegrino, MD* • www.ProHealth.com • June 8, 2011


It is not surprising that people with fibromyalgia are interested in alternative medicine approaches.

If there is one area in which conventional medicine often fails, it is in the management of conditions causing chronic pain.

Conventional medicine emphasizes the diagnosis and pharmacologic treatment of various medical conditions based on scientific research. The main philosophy is to identify the cause of the disease and treat it with medicines or surgeries to eliminate the cause. But if someone has chronic pain, does not respond to medications, is not a candidate for a surgical procedure, and has had numerous diagnostic tests that were normal, conventional medicine may be helpless.

Complementary or alternative medicine strategies emphasize the interaction between the body and the mind. The main focus is on maintaining homeostasis, which is the body's natural ability to maintain a stable harmony and balance among its hormones, enzymes, muscles, and organs to prevent disease or to allow the body to heal itself... And an increased number of scientific studies are being published that support the effectiveness of many complementary medicine treatments.

[But in fact] most conditions that doctors treat do not have scientific studies that "prove" a particular treatment is effective. That does not stop us from treating conditions, nor should it. Medical practitioners need to be open-minded. If we always waited for scientific proof, most diseases that exist would not be treated.

Placebo Effect

I remember learning that the placebo effect was “bad.” The placebo effect occurred when a person reported improvement in pain (or other symptoms) after being given a sugar pill instead of the actual drug (or other treatment).

The placebo effect has to be accounted for in any scientific research study because a placebo response does not measure the effect of the drug or treatment being tested. So as not to mistakenly attribute all of the positive benefits to the drug being tested to a placebo effect, research studies are designed to “cancel out” the placebo effect.

Placebo is derived from the Latin word that means “I will please.” It is a positive human response to hopefulness and wanting to get better with a treatment.

Even though the person wasn’t given an actual research drug, she or he felt measurably better simply because of HOPE.

Studies show the placebo effect may happen up to 30% of the time with any treatment. This means 3 of 10 people will feel better when given any type of treatment, with no obvious relationship to the actual treatment.

The placebo effect is a powerful physician “tool” that is not limited to a pill.

Suggestions that a physician makes can have a dramatic effect on how a patient will respond to a particular treatment.

In a study done by Drs. Staats and Hekmat (1998)(1), the role of one’s pain threshold in response to suggestion was examined. Three groups of college students were to place their hands in a tank of ice water. Each group was instructed differently.

• The first group was told “neutral” things: Don’t think about anything, just keep your hand in the water until you need to remove it.

• The second group was told “positive” things: Ice water can improve circulation, strengthen the heart, cleanse the skin cells, and other beneficial effects.

• The third group was told “negative” things: Ice water can be dangerous by causing numbness, decrease in blood flow, tissue damage and hypertension.

All three groups were told to keep their hands immersed until they couldn’t tolerate the pain any more.

Guess what happened? The “positive” group held their hands in longer and reported less anxiety. The “negative group took their hands out much quicker and reported more anxiety. The “neutral” group was in between the other groups.

This study demonstrated how the physician can affect the patient’s response to treatment.

Reassuring, positive words are more likely to increase the therapeutic response – cause a positive placebo response.


I have found much better responses to medications in my patients when I explain what to expect - and tell them the medicines may help but won’t take away all the pain – than if I just gave them the medicines and said, “Take this and let me know if it helps.”

A number of years ago it dawned on me that the placebo response from hopefulness and one’s desire to improve is EXACTLY what we are trying to accomplish in the treatment of chronic pain related to fibromyalgia. We want people to feel better, even if we can’t explain how it happened.

This approach would seem to be one of the major philosophies of complementary medicine - to improve the well-being of body and mind.

With this realization, I’ve washed out all of the negative connotations I learned about placebos from conventional medicine and have become more open-minded. Now one of my philosophies is: Welcome Placebo! We WANT to achieve a positive placebo response.

___

1. “Suggestion/placebo effects on pain: Negative as well as positive.”

* Mark J Pellegrino, MD, is a fibromyalgia specialist who has had fibro himself since childhood. An MD with a specialty in physiatry – physical medicine and rehabilitation - he sees patients at the Ohio Pain & Rehab Specialists Center, and has treated thousands of people with fibromyalgia and other chronic pain conditions. This article is excerpted with kind permission from his book Fibromyalgia: Up Close & Personal © Anadem Publishing, Inc. and Mark Pellegrino, MD, 2005.




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