Why does a placebo pill help back pain?
Have you been confused, perhaps upset, by all the hype around the BBC Horizon programme yesterday – Can my brain cure my body? Maybe you didn’t see it and you’ve read one of the many related articles.
A placebo treatment is a ‘fake treatment’. In this case it was a blue ground rice pill prescribed for long-term back pain sufferers. The programme showed how taking a blue placebo pill dramatically improved some people’s back pain. The time they spent with their GP had a significant effect on the outcome.
Does this mean they were faking their back pain? These people had suffered with their pain for years and were on all sorts of medication. Persistent pain was having a significant impact on every aspect of their daily life. Their pain is very real. Their pain is not ‘all in their head’, it is in all of their life – work, home life, relationships, hobbies and exercise, normal everyday activities – everything is affected.
We know that the body has specific time frames for healing after an injury. Any initial injury will have healed. However the pain continues – it’s like an alarm that has got stuck on. The purpose of pain is to warn you of harm or the potential of harm. When pain persists it is over-protective and pain occurs when you use your back or when you don’t use it, or when you do certain activities or try new activities, it can be triggered by circumstances, situations, emotions, tiredness, and your general well-being. The pain is very real and although it is the brain that tells you that an area is in danger of harm the pain is definitely not faked.
Why does placebo work? The placebo effect is still a bit of a mystery.
There are many theories about why a placebo might work, these are some of them drawing from understanding of pain science:
It may because of a learned response. Over the years the body has learned that if you take a pill it improves your symptoms.
It could because of a change in treatment. If you have been on the same medication for many years your body knows how to respond. Changing the pill may have been enough to stimulate a fresh and different response to a new input. We can see this in clinic where you teach someone to move in a slightly different way and it stops triggering the pain – a learned pain response can be altered by changing the input or circumstances.
Maybe you simply believe it will work. There is no risk involved and if you know that placebo can have a powerful effect, maybe it would work for you. Placebo works even when people know they are having a placebo treatment.
In the Horizon experiment the time spent with the GP had a significant impact on the outcome. Being listened to and feeling understood is so important for a positive improvement.
Not everyone responded positively to the placebo – maybe because they did not believe it would work. Perhaps it wasn’t the right stimulus for them and another factor would need to be changed to help break their cycle of pain.
The aim of treatment with pain that has been present for months or years is not to take away the pain completely, this is impossible. Life simply isn’t pain free – whether that is physical or emotional pain. The aim is to change the pain experience providing the opportunity for people to start rebuilding their lives – returning to activities they enjoy, achieving their goals. This is successful pain treatment.