The Placebo Effect: What is it?

Remember those sweet sugary pills that your mother gave you to calm you down when you scratched an elbow or a knee? You used to feel all well and raring to go! Mothers have a way with kids who keep running into trouble. Scientists and doctors took this a step further and tried testing the effects of mind over matter by giving patients “pills” without the active ingredients for treating a particular disorder, and guess what? Many reported feeling better!

Wondering about the correlation between the bottles of sweetmeat your mom lovingly treated you to and the “fake” pills that the medical personnel might treat you to, whether knowingly or unknowingly? There is a word for this “pill” or “treatment” that does not include the active ingredient or salt responsible for treating the ailment one may be afflicted with. The word in question is “placebo,” which comes from the Latin word “placere,” meaning “to please.”

Placebo refers to any mode of treatment, whether sugar pills, sham surgery, saline injections, etc., without the actual drug or procedure responsible for treating conditions. Have you ever noticed a quick response to the suggested treatment when the doctor appears optimistic about the results? Yes, the mind has the power to believe and release the body’s natural healing endorphins, resulting in an improved physical or mental state. This interesting connection between the enhanced rate of recovery or perceived relief by administering a pill without the active ingredient will be our topic of discussion in the sections that follow.

A Brief Overview

The thought that the mind can cure body ailments has been around for eons. However, there is more to the placebo effect than just positive thinking. A fake pill may help you feel lower pain levels but not cure the root. According to Professor Ted Kaptchuk, affiliated with Beth Israel Deaconess Medical Center, who has extensively researched the placebo effect, “Placebos are most effective for conditions like pain management, stress-related insomnia, and cancer treatment side effects like fatigue and nausea.”

This works by strengthening the connection between the mind and the physical framework. At this point, it is imperative to distinguish between the terms placebo and placebo effect clearly. While placebo refers to the actual physical pill, injectable, or fake surgery sans the active therapeutic ingredient or the procedure required to heal an ailment, the placebo effect refers to the way the body responds. Whether positively or negatively, the administration of the fake “treatment” cannot be attributed to any other active mode of treatment.

How is it Used?

For a long time, placebos have been used in clinical trials to test a new drug’s efficacy. To ensure ethical compliance, participants in the clinical trial are pre-informed that they may be subjected to a “dummy” treatment. The use of placebos has come a long way from being used as a control group in medical research to being tested as a treatment mode in themselves. Let us have a look at some of the clinical trials employing the use of placebos.

Mostly one group of the participants received the new drug. In contrast, another group, known as the “control” group, is given a placebo (for example, a sugar pill without the active ingredient). In specific trials, the participants are unaware of the nature of the substance administered to them. In other cases, even the researchers are not privy to this information to prevent researcher bias. This is also known as the double-blind test.

The efficacy of the new treatment can be judged by comparing the difference in the result from both groups. About one-third of those given the dummy medication express relief in pain, seasickness, and headache symptoms.

Here’s how placebos are used to manage symptoms if not cure the disease:

• Pain: There is an interesting concept of placebo analgesia doing the rounds in medical circles wherein patients report reduced pain either by experiencing the release of contextual cues-induced natural pain relievers such as endorphins or the changed perception of an individual’s level of pain. The simple act of taking a pill coupled with encouraging words of reduction in pain can contribute to the patient’s altered perception of the magnitude of the pain experienced.
• Depression: Contrary to the common perception that the placebo response in treating depression is not for the long term, a study has shown that the use of placebo antidepressants in 4 out of 5 placebo responders did not meet the criteria for relapse.

How Does it Work?

Though the placebo effect is experienced differently by different people and has a varied impact on a range of ailments, it is highly plausible that there may be more than one factor at work. Researchers are still trying to crack the code behind the placebo results. The following are the four factors behind the efficacy of placebo treatment and perceived reduction in pain, anxiety, or discomfort.

• Expectation and conditioning: Though both are separate mechanisms, they are thought to have a common connection. A simple correlation between classical conditioning and the placebo effect can be the connection between popping a pill and the associated feeling of relief. The act of taking a pill can elicit a positive response.
  Another factor thought to be at play is the person’s expectations. If the person feels that they are in good hands and the treatment is likely to work, they may experience a reduction in stress hormones or experience a reduction in the perception of the pain intensity. For instance, a debilitating or shooting pain might be described as an uncomfortable tingling sensation.
  On the contrary, if the person is informed about the expected side effects, such as fatigue, feeling low, or experiencing headaches, there may be adverse outcomes despite the absence of the active ingredient in the fake pill administered. In such cases, the placebo is called a nocebo or one with a negative effect.
• The correlation between the placebo effect and the brain: PET scans of those experiencing placebo analgesia or pain relief after being administered a pill without the active ingredient have shown distinct, measurable changes in neural activity. The following areas of the CNS are involved; nucleus accumbens, amygdala, spinal cord, and brain stem. Interestingly, hard-to-miss placebo and conversely nocebo responses have been found to increase or decrease dopamine and opioid receptor activity, respectively. These chemicals are known to be involved in regulating the reward and motivation pathways in the brain.
• Psychoneuroimmunology: A relatively new field of scientific endeavor, psychoneuroimmunology aims to study the direct effect of changes in brain activity on a person’s immune system. Much like the leaders in our family who advised us to look for the silver lining in the clouds to lead a longer and healthier life, pseudoscience might have found scientific evidence! If we tried to expect improved energy or health levels and worked toward adopting a healthier lifestyle, we might just notice a boost in our immune system!
• Evolved health regulation: Much in tandem with the philosophy or science of Darwinism, the physiology of mammals has evolved suitable adaptations and responses to eliminate or stave off pathogen-induced responses. For instance, a rise in internal body temperature or fever is designed to fight off pathogens. However, in cases of malnutrition or late pregnancy, the brain does not kick off the fever response as the cost may not be worth the effort. The high temperature may harm the fetus, and the increased ATP requirement may tax the already shortened energy supplies in case of severe malnutrition.

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Does it Mean the Illness is Not Real?

Many may feel that if a placebo can cure the symptoms of an ailment, the illness may never have existed in the first place! That simply isn’t true. Medical research is testimony to the fact that an individual’s mental state has an irrefutable role in the pathogenesis of a disease. For instance, high-stress levels can trigger an increase in blood pressure, contributing to CHD or Coronary Heart Disease.

What is the “Nocebo” Effect?

As mentioned in the previous sections, a placebo works in accordance with the patient’s expectations or the doctor’s prognosis. Suppose the doctor tells the patient that the treatment is likely to work smoothly. In that case, the patient has a high tendency to experience positive outcomes with reduced pain perception, whereas on the contrary, if the doctor tells the patient about the expected negative side effects of the treatment, such as nausea, fatigue, constipation (in case of certain antidepressants) he/s she is predisposed to experiencing such negative side effects. Also known as the nocebo effect, it can be experienced in both the cases of active drug or placebo pill administration.

What are Open-Label Placebos?

Some sections of the medical society are not in support of using placebos on account of keeping the patient in the dark about the lack of any active ingredient being administered in the name of treatment. Therefore, some clinical studies employ open-placebo studies wherein the participants are pre-informed about the lack of any active ingredient in the pills or treatment they are given.

Interestingly people have still responded positively to open-placebo studies. This can be attributed to:

• The simple act of taking a pill triggers the conditioned response of feeling better.
• Expectations of reduced pain levels.
• The feeling of hopefulness associated with participating in a clinical study.
• The natural bodily fluctuations in pain perception are triggered by the release of endorphins triggered by placebo ingestion.

Seek Treatment from a Trusted Provider With DocVita Today

Though the research on placebos and their effect on an individual’s mental and physical health is an ongoing endeavor, one should seek out help for self or one’s loved ones from trained medical professionals at the earliest. If you have been feeling the blues on a sustained basis and are looking for the right medications for mental health, please know that help is at hand!

You don’t need to step out of your comfort zone and can easily avail the treatment you deserve from the comfort of your home and in the language of your choice. All you need to do is book a consultation call with a licensed therapist of your choice at DocVita, and a care manager will be assigned to you at the earliest. The journey to holistic wellness begins here.