Despite being the most common health-related disability in the UAE, there’s rarely any good news about the treatment of chronic pain. Now a radical new approach is showing promise. It can provide long-lasting relief, has no side-effects and costs virtually nothing.
But it’s also highly controversial and more than a little bizarre. That’s because it requires patients to take... sugar pills.
Doctors have long known it’s possible to get genuine benefit from taking some inert substance instead of a genuine medicine. But the power of the so-called placebo effect – from the Latin for “I shall please” - is also widely viewed with suspicion.
The reason is that it only works if patients are tricked into believing they’re taking a proven remedy – an approach many doctors regard as unethical, whatever the benefits.
But now researchers are discovering placebos can work even when patients are told what they’re getting.
This perplexing discovery is sparking a rethink on the use of placebos in medicine – and one with special importance for those in the UAE.
That’s because some of the ailments likely to respond to placebo treatment are currently treated using potentially addictive compounds subject to tight regulation – so tight that patients can end up under-medicated.
Containing no active ingredient, placebos have no such drawbacks.
All of which raises the question: how can they possibly work ?
Sceptical doctors have long dismissed any benefit from placebos as being “all in the mind”, but it’s increasingly clear this isn’t the knock-out argument it may seem.
Over the years scientists have found that patients with chronic pain given placebos show changes in the same areas of their brain as those affected by powerful morphine-like pain-killers. Similar effects have been found for patients with depression.
Such findings suggest placebos somehow trigger the body’s own systems to deal with ailments.
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The discovery that they can still do this even when patients know full-well they’re being given “nothing” opens the way to their wider use.
A recent review of such “open-label” placebo treatments found evidence for their effectiveness with a wide range of disorders, from Attention Deficit Hyperactivity Disorder (ADHD) to Irritable Bowel Syndrome (IBS).
Some of the most impressive results were found for lower back pain, one of the most common medical conditions in the Emirates.
Researchers found that patients told to take two placebo pills twice a day for three weeks actually did better than those given standard treatment for chronic back pain.
While the studies showed the effectiveness of open-label treatment, the explanation remains elusive.
They are, however, in line with research suggesting that just taking the placebos – knowingly or not – may not be enough.
As the Russian physiologist Ivan Pavlov’s famously showed in experiments with dogs, real physical responses can be triggered in living organisms by “conditioning” them first.
Pavlov got dogs to salivate by simply ringing a bell, after conditioning them to link the sound with being fed.
In the case of patients, the conditioning involves getting the patients to link taking the placebo with the possibility of feeling better.
Research has shown that the “bedside manner” of the doctors plays a role in the success of such conditioning.
In one UK-based study, a group of patients was given a clear, firm diagnosis of their and told they would soon be better – with some then being left untreated.
Meanwhile another group received a vague diagnosis and no assurance about recovery, regardless of whether they received treatment or not.
The results were spectacular. Almost two-thirds of those patients given a positive consultation got better, compared to just 39 per cent of those getting the downbeat assessment. Whether they actually were treated or not made no difference at all.
In other words, the attitude of the doctors had far more effect on how the patients fared than the medicines they were given.
The way the treatment is given also seems to matter, with injections typically giving better results than pills.
But even the colour of the pills can have an effect.
In one of the most celebrated studies into the placebo effect, carried out in the early 1970s, patients given sedatives were over twice as likely to feel drowsy as those given a powerful stimulant.
Which is no surprise - except both sets of patients had actually been given the same harmless compound. The only difference was that the sedative was a relaxing shade of blue, while the stimulant came in a perky shade of pink.
The discovery that placebos can work even when patients know what they’re getting is the latest twist in one of the most controversial issues in medicine.
Clearly more research is needed if treatment with placebos is to win over the skeptics. But some caveats are already clear.
First, the technique is no panacea. Decades of research have shown that while it can bring relief from some conditions like chronic pain, migraine and depression, it is no cure – and is useless against diseases like cancer and Alzheimer’s.
Nor will it work for everyone. Research published earlier this month in Nature Communications showed that patients with certain psychological traits – such as emotional awareness and openness to experience - are more likely to respond than others. The researchers also found that the architecture of the brain may also play a role.
But there is one group of people who will not be remotely surprised by any of this: practitioners of so-called alternative medicine.
They have always insisted that techniques ranging from acupuncture to homeopathy can bring genuine relief to certain conditions.
Such claims have long been dismissed as unfounded, unscientific and potentially dangerous.
At the very least, the latest discoveries about the placebo effect suggest we still have much to learn about the body’s ability to treat itself.
Robert Matthews is Visiting Professor of Science at Aston University, Birmingham, UK
