KNOWINGLY TAKING PLACEBO PILLS EASES PAIN

A new study is the first to demonstrate that patients who knowingly take placebos or "fake pills" for lower back pain, still resulted in a 30 percent ease in pain and 29 percent decrease in disability when compared to the control group. This study essentially redefines the effects placebo pills has on health and wellness. A paper published in the journal Pain demonstrated how those given open-label placebo pills had improvements which, superseded those of patients who only received the traditional medications for lower back pain. 

                

         

Ted Kaptchuk, director of the Program for Placebo Studies and Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard medical School states, "These findings completely turn our understanding of the placebo effect on its head. This new research demonstrates that the placebo effect is not necessarily elicited by patients' conscious expectation that they are getting an active medicine, as long thought. Taking a pill in the context of a patient-clinician relationship--even if you know it's a placebo--is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms." When a patient interacts with their doctors or nurses during treatment, the psychological effect of feeling cared for, of empathy and of trust, can lead to a positive physiological effect, whether the medication is active or not.

While it shouldn't replace medications for tumors or other extreme ailments, the study shows that the placebo effect holds precedent and can to relieve symptoms, such as back pain to a degree without invoking a physiological effect on the body.

References:

    1. Beth Isreal Deaconess Medical Center. "Knowingly taking placebo pills eases pain, study finds." ScienceDaily. ScienceDaily, 14 October 2016. <www.scienccedaily.com/releases/2016/10/161014214919.htm>.

    2. Claudia Carvalho, Joaquim Machado Caetano, Lidia Cunha, Paula Rebouta, Ted J. Kaptchuk, Irving Kirsch. open-label placebo treatment in chronic low back pain. PAIN, 2016; 1 DOI: 10.1097/j.pain.0000000000000700

The placebome: Where genetics and the placebo effect meet

Does genetics play a role in the placebo effect?

The use of a placebo has been present in randomized clinical trials to show the effect of a new drug related treatment for years. With the uprise in genomic studies researchers have learned that an individuals response to a placebo can be modified by a persons genetics. In the article researchers from the Program in Placebo Studies (PiPS) at Beth Israel Deaconess Medical Center (BIDMC) and the Department of Medicine at Brigham and Woman’s Hospital (BWH) have explored the evidence of placebo studies and introduced the concept of “the placebome.” The placebome is a term used to denote the study of genomic effects on the placebo response and the article provides concepts for future research and discussion for the role of the placebome in health care.
As the article explains it is known that genetic variations in the brain’s neurotransmitter pathways modify placebo effects and by identifying plaebo biomarkers we can show these variations. Catechol-O-methyltransferase (COMT) is a biomarker that has an influence on the brains levels of dopamine, and therefore the extent of an individuals placebo response. Research has also shown that there is genetic variation in other neurotransmitter pathways that could modify ones response to the placebo including: opioid, endocannabanoid and serotonin pathways. This shows that a network of genes may be responsible for this effect.

This new knowledge has allowed researchers to pose questions such as the relationship between placebo-drug interactions, of which I found very interesting. It was mentioned that the neurotransmitter pathways at work are the same in both the placebo and the drug. For this reason the response of the drug could have been modified by the placebo, or vice-versa. I found this article intriguing because the implications of these placebo-drug interactions means that there may be a discrepancy in the validity of clinical drug trials. I am interested to see if placebo control groups will be altered in any way in the future.

Primary article can be found here

Placebo Effect

New research suggests that the strength of the Placebo effect could be affected by one's genes.

Scientists have been researching how one's genes can affect how a  positive effect a placebo will have. Studies suggest that better knowledge of this area could make for more effective treatments.The effectiveness lies in genetic signatures and the likelihood to have a beneficial response. Studies have found that when presented positively, the placebo has a beneficial response, even when people know that the drug is a placebo. Even when the drug is real, the effect is more positive when the patient knows their taken it. ___

The key area of research seems to be important is the production of dopamine, a neurotransmitter that is involved in both pleasure and movement. The way that each person's brain interacts with neurotransmitters determines how they perceive sensations and symptoms. There are many variations within the genes that could play a factor in the effectiveness of the placebo effect.

The ethical questions lies in whether mapping this area of research would make drug research more effective. Is it ethical to give a patient with a stronger placebo effect a lesser dose compared with someone who does not? Could placebos boost the effectiveness of drugs? These questions are all being researched more and are being integrated into modern medicine.

Link: http://www.philly.com/philly/health/topics/HealthDay698336_20150413_Genes_May_Make__Placebo_Effect__Stronger_for_Some__Study_Says.html