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More about placebo

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  • More about placebo

    A multitude of things might contribute to feelings of relief when we see a practitioner and some “method” is employed in order to help. It’s hard to sort out what might be the most significant of these.

    …what the brain expects to happen in the near future affects its physiological state.

    From this New Yorker article
    I found the article on Rey Allen’s page on Facebook.

    Once again, the issue of placebo rises to the fore, and its effect is greater, more benign and more specific then previously thought.

    I’ve more to say.

    I know you do too.
    Barrett L. Dorko

  • #2
    I just finished Gifford's chapter on placebo, nocebo, and pain-on and pain-off systems. He goes in depth on Benedetti's work and some of the fantastic studies that he has done that have demonstrated such clear and specific mechanisms for both increases and decreases in pain by suggestion alone. It should be required reading for anyone involved with treating patients in pain.

    I'll link the study here in case anyone is interested.
    Ryan Appell DPT


    • #3
      In an airport I saw The Art of Stillness - Adventures In Going Nowhere and bought it immediately.

      If I ever go looking for my heart’s desire again, I won’t look any further than my own back yard. Because if it isn’t there, I never really lost it to begin with.

      Dorothy, at the beginning of this book
      Placebo is a response. Famously, Wall says it’s something we receive from the patient – not something we give them. Undoubtedly, we can somehow create a context that allows them to respond.

      “That is the difficult truth. If you needed help and you came to me, you would get better. Thousands of people have. Because, in the end, it isn’t really about the needles (in acupuncture). It’s about the man.”

      Ted Kaptchuk
      Barrett L. Dorko


      • #4
        Hi Barrett!

        Perhaps the best contemporary example of the placebo effect in sports is the speed skating suits Under Armour designed for the Sochi Olympic Games. The company invested a considerable amount of time and money in wind tunnel testing and fabric design.

        However, when our top skaters were underperforming, the suits were the clear focus in trying to explain the sub par performances.

        American skaters were allowed to go back to an earlier suit, and many believe that was a good decision.

        As Mark McClusky notes in Faster, Higher, Stronger:

        "As soon as the skaters wondered if the new suit was slower, it was. And that has nothing to do with the technology in the suit. It has to do with the effect of belief in athletes. Belief effects (or the placebo effect) are a powerful force in our lives. For athletes, they can be a crucial part of being as ready as possible to compete."

        In quoting an editorial on the role of the placebo effect:

        "Sports scientists have often observed that just believing in a novel and exciting performance-enhancement treatment can produce improvements in performance regardless of introducing a real treatment effect."

        McClusky believes the reverse can also happen. "As soon as you start to worry that something is slowing you down, it's probably going to do just that. That's why it was a good call for the U.S. skaters to switch back to the old suits when doubts were raised about the new ones."


        • #5
          I really like this thread from '09.

          In post #11 I actually use the words "I believe." I was feeling more sanguine regarding the impact of rationality in the therapies back then. Now I've abandoned the phrase because I think I know better.

          Actually, I wonder about what I seem to "know" now.
          Barrett L. Dorko


          • #6
            In the thread linked above Luke Rickards writes:

            If all attention here should be directed at methods of increasing patient expectation and developing the most convincing medical (or PT) rituals then it seems that, for example, basing manual care on the minutia of ruffini receptor response to the specific dynamics of mechanical input to the skin, or positioning neural tissue for the purposes of improved oxygenation, might be considered a waste of time.
            I answered:

            One year ago you wrote a post in the “Suppose this were true” thread that helped me immensely during a real crisis in my understanding. This is a portion of post #57:

            "…it is clear that input to map representation at various levels may be sufficient to convince the brain that threat has been resolved, eg, CRPS is reduced by both higher level motor input and visual input representation. The existence of placebo would rule out the claim that any aspect of therapy, other than expectation, is necessary, but that doesn't mean that input into the motor representation maps is not sufficient to resolve a discordance (if that is truly the problem)."

            This brilliant distinction between what is necessary and what is sufficient helped me again see the worth of my efforts and dedication to study and actual practice - at a time when I felt a creeping despair regarding both. This was no small thing and I will be forever grateful.
            Barrett L. Dorko


            • #7
              Going nowhere…is not about austerity so much as about coming closer to one’s senses.

              Pico Iyer
              I do less and less and understand more and more.

              It’s tough to teach, but I’m working on it.

              Understanding more about placebo is essential to this.
              Barrett L. Dorko


              • #8
                Having landed here (on Soma Simple), each of us has a decision to make about how we might continue to practice. Having to satisfy the patient, the referral source, our bosses, the payer and our own curiosity regarding the deep model, many methods have emerged and each may be defended from one or more of these perspectives. That last one less often than the others, it seems.

                As time goes on some of these viewpoints rise or fall in significance but the last one has always compelled me the most. No wonder my struggle to communicate or relate to my colleagues.

                Me, in post #14 of this thread
                Now I use the word premise a lot. Previously I often said deep model.

                The former should be stated simply, clearly and as completely as possible. It should defended rationally.

                The latter isn't visible to the naked eye, but it has the same task as the former.
                Barrett L. Dorko