Does taking a placebo, such as a pill that only contains ground rice, really help to cure back pain? Jim Pearce is convinced that yes. And there is a scientific reason that can explain why. When we first met, Pearce was 71 years old and confined to a wheelchair. He had to use morphine to make his back pain more bearable. But after participating in a study conducted by the BBC with the help of health experts, he began taking “new” analgesics, very similar to those traditionally taken for his type of injury. But these were nothing more than placebos, pills that did not contain any kind of medicine. How a doctor’s words can make you sickHe is sure that they worked for him. “I woke up one morning and I said to myself: ‘I do not feel that sting in my back anymore and I feel it stronger'”.I asked him if he would prefer to continue taking morphine or to definitely switch to the blue-striped pills we had given him. “I have already got rid of the morphine and I have continued taking the pills”, he confessed. This British septuagenarian was one of the 100 people who participated in an experiment that the BBC made for the Horizon program and in which we try to solve if the brain can really cure the body. To perform our study, we chose to treat people with chronic back pain, one of the most difficult to alleviate. But there was a trick. All of our volunteers were going to take placebo pills, although they did not know it. 3 ways to fight back pain without medicationThe aim of the experiment was to find out if they would think that their pain had improved despite the fake pills. ¿Real or unreal?The placebo effect is a concept well studied in medicine but still remains a mystery. The word comes from the Latin “I would like to please” and is associated with images of healers who sell unreliable cures. Today, however, it is an important part of modern clinical trials in which patients are given a placebo (sometimes called a dummy pill) or an active drug (not knowing which is which) and the researchers then observe if the drug overcomes the effects of placebo. Or vice versa. With the help of Dr. Jeremy Howick, an expert in the placebo effect of the University of Oxford (England), we set out to find out if we could cure back pain with false pills. It would be the largest experiment of its kind ever conducted in the United Kingdom, with the participation of 100 people from Blackpool, a coastal city in north-west England. Some were asked to act as a “control” group. The rest were told that they were participating in a study, where they could either receive a placebo or a very new type of very powerful analgesic. What we did not tell them was that everyone, in fact, would be taking some capsules that did not contain more than ground rice. The pills seemed very authentic, with blue and white stripes, because it has been shown that they have the greatest calming effect.They came in carefully labeled containers warning of possible side effects and reminding patients to keep them out of the reach of children. All very convincing. Would it work? Before giving us his assessment, Pearce told us: “I am not looking for miracles, it would be good, even if the pain disappeared a little, to give me more freedom”. “I’ll try anything and if it works, I’ll love this remedy forever!” He said. The methodAll of our volunteers had been suffering from back problems for years and felt that their medication was not helping them enough. When they came to us, we arbitrarily divided them into two groups. One did not receive more than nine minutes and 22 seconds of consultation with the family doctor to talk about his problem before receiving the medication. They were quickly dispatched. That’s the average length of a consultation at the GP in England. The other group received more than double the time. We wanted to see how long the medical examination could have some kind of influence on the results. Many people believe that the placebo effect is a scam and that it only works for the credulous. But that’s not what science shows. Nor our experiment.Professor at the University of Oxford, Irene Tracey, told us that just because a placebo does not contain active chemicals, does not mean that the effects of taking it are not real, “he said. “The average person thinks that the placebo is a lie or a falsehood, but science has told us, particularly in the last two decades, that it is something that is very real, something we can see in our physiology and neurochemistry.” Different studies have shown that taking a placebo can trigger the release of endorphins, natural analgesics similar in structure to morphine. “I have not felt a twinge”When we returned to Blackpool after three weeks, our volunteers underwent several tests and questionnaires. We discovered that half of them had found significant relief when taking the pills, even though they were false.As with Pearce, we talked to Joe, who had told me that his back hurts so badly that he had to take morphine and ketamine “to get out of the house.” He said he had not felt a twinge since he started taking the pills. In fact, almost half of our volunteers declared a medically significant improvement in reference to their back pain. Considering that all of them had tried all the analgesics on the market, from tramadol to morphine, I found the results quite surprising. The time spent in consultation with the doctor also affected the results. Those who had a longer consultation said they felt greater benefits with the treatment. So, where does this leave modern medicine? A recent article in the British Medical Journal suggests that it may be ethical to prescribe placebos, as long as doctors are honest about what they are doing. The paper notes that there is increasing evidence, though small-scale trials, that placebos can work even when patients know they are taking them. That way, you can get the benefits of pain control without the side effects and often significant effects of taking a “real” medication. Credits: BBC News

 

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