First of all, I am going to explain to you why I decided to write this blog post. There are many patients and friends that ask me “does acupuncture actually work?”, “what about massage, does it work?”, “is the treatment with dry needles any good”, “is yoga recommended?”, “are stretches useful?”, “my friend told me that Pilates worked very well for back injuries, is it true?”. My answer is always the same “give it a go and if it works for you, it is good for you”. There is not good research about every single therapy, actually there is not good research about many therapies. If a friend or family member tells you that something worked for him/her, it could be also good for you. The result of a treatment might be supported by evidence or not, but the important thing is that it might help you. It could be that the therapy itself is a “fake” treatment, but if it works for you, why to say “no” to it. Now, this is the moment to talk about placebo and placebo effect.
I am pretty sure that many of you know what placebo effect is, although I am also sure that many of you don´t know how important it is in your daily life and the fact that placebo have superpowers. I am going to explain to you with a brief definition and different examples what it is.
The word placebo means “I will please”. Placebo is defined as any type of “fake” treatment that seems to be real to the patient. Now, we need to talk about the placebo effect, or also called placebo response. Placebo effect is the response of the patient to placebo, which can be positive and, according to some people, also negative (although in this case it is usually called nocebo, “I shall harm”). Basically, the person is given a treatment that is not meant to affect health and it does. This is a pretty basic explanation, but I am sure you are going to understand it better by reading examples based on true story.
I have different examples to share with you. Let´s start with the typical one, the one I am sure you have already heard about.
Placebo effect example 1:
The pills and the medical students
Two groups of medical students (56 in total) were given a pill, either one which was said to be a stimulant or one which was said to be a sedative. Although, neither the “stimulant” pill nor the “sedative” were actually stimulant or sedative. Yes, they were “fake”, probably they were just made of a bit of sugar. However, many of the students who took the “stimulant” pill reported to feel less tired and more than two/thirds of the students who took the “sedative” pill reported to feel drowsy (some of them took two “sedative” pills and reported to feel sleepier than those who took one). Also, a third of all students reported side effects such as headaches and tingling. Ready for more data? Only 5% of the students reported no effects. Yes, you got it right, only 5% of 56 students. The placebo effect can be this great, hehe…
This study is from the book Neurosciense (2nd edition). The amount of students might not be big enough to consider this study important, although it is a good example to make you understand what placebo response is about.
Placebo effect example 2:
The ultrasound therapy and the “I will recommend it to everyone” (note that I was the physio in this case)
Patient, 42 years old. “My doctor told me that I need ultrasound therapy for my knee, he touched the tendon which is on the outside of my knee and it hurt. He says that I got tendinitis on the outside of my knee”. One of the interesting things in this case is that the patient didn´t feel pain on the outside of his knee, but on the inside (when walking around). After a complete Physiotherapy assessment, the final diagnosis was tendinopathy (wrongly called tendinitis, check the why in this article) of one of the hamstring muscles (strange funny names are not needed) that inserts into the inside of the knee, not the outside (note that healthy tendons can be painful on palpation, so compare one leg with the other one before you give a wrong diagnosis). Ultrasound therapy is not supported by strong evidence, so I recommended a different treatment. However, many times, patients refuse different opinions and stuck with “my doctor said…”. What I did then might sound very bad, I am sorry about it (or maybe not). I said “okay, no problem, let´s try with ultrasound therapy”. At this point, I remembered that the ultrasound machine had been broken for a week, oops. “Never mind, let´s try anyway”, I said to myself. Ultrasound treatment done and patient feeling much better straight away. “I will recommend ultrasound therapy to all my friends”, he said. You see, placebo is awesome.
Note: the ultrasound machine was repaired the following week.
Placebo effect example 3 (for this example I will give you three titles to be analysed):
The psychologist doctor/physiotherapist and the “my doctor/physio is very nice”, the positive patient and the good relationship with the doctor/physio and the negative patient and the grumpy doctor/physio.
There is evidence that shows the relation between the patient-practitioner interaction and placebo effect.
In a study by John M Kelley et al. three different groups of patients with irritable bowel syndrome were treated with placebo acupuncture in three different ways each of them. One in a warm and empathic interaction, another in a neutral interaction and the third one was a waistlist control.
The patient personality influenced placebo effect only in the group with a warm and empathic interaction. I have always said that the best treatment for patients is to be nice to them, apparently I wasn’t too wrong.
There is another interesting example about cyclists that you might want to read. It is a study by the Canterbury Christ Church University.
I hope you have enjoyed this particular way of explaining things. Don’t hesitate to share anything related to this topic by leaving a comment. As always, you can find us in our Physiotherapy Clinic in Southampton, The Physical Therapy.
This is the Spanish version Placebo es un superhéroe from our blog La Fisioterapia.net.