By Gabriela Pierre, L.Ac.
We’ve all heard the term mind over matter.
Generally, mind is understood to be synonymous with willpower in this motivational mantra. But what if we expanded the definition to encompass a wider meaning that not only includes our indomitable spirit but also our physical brain? If you have ever wondered how powerful an effect our minds have on our health and state of well-being, you are seeking to understand the very real and very elusive phenomenon that controlled scientific studies have disparagingly labeled as placebo effects.
While it may be challenging to tease out and quantify mathematically, placebo plays an important role in our health care experience. That experience begins the moment a patient interacts with a health care provider, however brief that encounter may be. What is said and how that information is communicated to the patient are key variables that can directly affect a patient’s prognosis. Factors such as time spent with a patient, bedside manner, warmth, empathy, physical reassurement and the communication of positive or negative expectations all play significant roles in health outcomes. [1]
This is especially true for patients with chronic illness who rely on ongoing care to manage their conditions. We have entered a new era of healthcare that is increasingly more integrative and addresses the inseverable connection between the mind and body. Mind-body medicine no longer exclusively resides in the realm of alternative and complementary medicine. Hard science has finally giving credence to the practice of mind-body medicine. Thanks to discoveries about pain control and stress management attributed to the placebo effect, the role of the mind as it relates to health and disease prognosis is once again entering Western health care full steam ahead. [2]
Unfortunately, the concept of placebo has gained a bad rap in the field of medicine since it became a codified standard in clinical trials. Having no pharmacological effect, placebo is most often used in clinical trials as a control for testing therapeutic interventions or pharmacological agents with known biological effects against fake or sham treatments. It wasn’t until more recently that some researchers have started to take a closer, more serious look at the placebo effect and have made a compelling case that there might also be a biological basis for the real effects produced by placebo controls on research participants.
It turns out that historically, clinical trials have greatly underestimated the real physiological implications that a person’s expectations of treatment have on treatment outcomes. In other words, our psychology is a powerful modulator of our physiology. Our perceptions and expectations have the power to quite literally activate different areas of our brains and trigger the release of various endogenous substances including endorphins, serotonin and opioids that can provide significant pain relief and elevate our mood. If you believe that a treatment will work, or conversely, that it won’t work, there is a good chance that you will be right either way. [3] The notion that we can distinctly separate our psychology from our biology is nothing short of impossible. We’ve come a long way from the Cartesian aphorism, I think, therefore I am to now assert that what we think can determine just how we are.
More than just a mystic self-fulfilling prophecy linking belief to behavior, some of us are biologically primed to respond to placebo. Preliminary research indicates that certain individuals with higher levels of dopamine are more likely to respond to placebo. [4] While we don’t fully understand which pain and pleasure pathways are activated and to what extent via the placebo effect, a strong case can be made for the effect placebo has in regulating various physiological processes including pain, mood, appetite, and memory. Research studies have shown that placebo may also have an effect on serotonin levels as well as our endocannabinoid system. [5] In fact, placebo can induce pain suppression in the body with an estimated analgesic effect equal to or greater than morphine. [6]
As physicians, caregivers, and patients alike, we cannot afford to underestimate the role our mental, emotional, social, and spiritual well-being affects our health down to the cellular level nor can we deny the importance of the patient-provider relationship in achieving desired health outcomes. Better understanding and implementation of the placebo effect has the potential to revolutionize medicine and change the way we deliver health care. Mind-body medicine that is practiced as a ritual of compassionate care can be the new gold standard of healthcare, ultimately giving patients their best chance at optimal health outcomes and longevity.
Note: The placebo effect imparts its benefits in addition to the non-placebo effects inherent to each type of medical intervention. If you’re interested in reading about acupuncture research that has been placebo-controlled, or some of the proposed non-placebo mechanisms of action for acupuncture, check out the links below:
Research
Electro-Acupuncture and IVF: https://www.ncbi.nlm.nih.gov/pubmed/21862001
Acupuncture and depression: https://www.ncbi.nlm.nih.gov/pubmed/27400468
Acupuncture and chronic low back pain: https://www.ncbi.nlm.nih.gov/pubmed/23026870
Acupuncture and migraines: https://www.ncbi.nlm.nih.gov/pubmed/27351677
Acupuncture and pediatric tonsillectomy pain: https://www.ncbi.nlm.nih.gov/pubmed/25851423
Acupuncture analgesia: https://www.ncbi.nlm.nih.gov/pubmed/24949296
Acupuncture and chronic pain: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036643/
Acupuncture, women’s health, mechanisms of action: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962314/
Acupuncture, mechanisms of action: https://www.ncbi.nlm.nih.gov/pubmed/11388686
Footnotes
1. Kaptchuk TJ, Kelley JM, Conboy LA, et al. (2008). Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ. 336(7651): 999-1003.
2. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=102
3. Wells, R. E. (2012, March). To Tell the Truth, the Whole Truth, May Do Patients Harm: The Problem of the Nocebo Effect for Informed Consent. Am J Bioeth,12(3), 22-29.
4. Coeliac L., Klinger R. Flor H. Bingel U. (2013). Placebo analgesia: psychological and neurobiological mechanisms. Pain. 154(4), 511-4.
5. Hall, K. T., & Loscalzo, J. (2015, May). Genetics and the placebo effect: The placebome. Trends in Molecular Medicine, 21(5), 285-294.
6. Hall, K. T., & Loscalzo, J. (2015, May). Genetics and the placebo effect: The placebome. Trends in Molecular Medicine, 21(5), 285-294.
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