Mind Games: Can Placebos Be Used To Treat Chronic Pain?

By Josiah M. Hesse 10/18/15

100 million people in the US suffer from chronic pain. You’d think we could come up with a treatment which didn't have such a high risk of drug abuse or addiction.

Can Placebos Be Used To Treat Chronic Pain?

New studies surrounding the placebo effect—the psychological phenomenon of belief in a substance being more powerful than the substance itself—has the potential to transform the way we look at drugs and addiction. While narcotics used to treat pain—or taken recreationally—definitely have a physiological effect on our brains and bodies, new studies are showing that the context, expectations and previous experiences we’ve had with a substance often play a large role in our final experience. 

As children many of us heard the phrase “it’s all in your head,” often in a dismissive tone, indicating that the thing you thought was real was not, because your brain made it up. While the statement itself is true, the implication isn’t. Because everything is in our head, especially pain.

“If I have pain in my hand, the pain is not actually in the hand, the pain is in my brain,” neurosurgeon Henry Marsh recently said during an interview on NPR’s Fresh Air. “My brain creates a three-dimensional model of the world and associates the nerve impulses coming from the pain receptors in my hand with pain in the hand, and it creates this illusion that the pain is actually in the hand itself, and it isn't.” 

While it’s true that pain can originate in our body’s nerves, it’s the brain that creates the sensation of discomfort, processing both the physical pain and the emotional reaction to that pain. Again, this doesn’t mean it’s not “real,” but it does suggest that we could be equally or perhaps more effectively treating chronic pain by looking at our options in the mind rather than the body. And few things teach us as much about the mind-body relationship than placebos. 

Currently, placebos are primarily used as a comparative tool to evaluate a drug’s effectiveness: You test a drug on a series of patients, then test a sugar-pill (or some other innocuous substance) on a similar group, along with a third group who take nothing, and then ask each how they feel. Take the recent New York Times headline “Steroid Shots No Better For Back Pain Than Placebo.” The implication of this is that the steroid shots aren’t working because they didn’t outperform the placebo. But what happens when the placebo turns out to be an effective treatment on its own? 

A 2008 study revealed that half of American doctors regularly prescribe placebos to their patients, sometimes for minor issues like headaches, but also as sedatives or antibiotics. The American Medical Association, as well as a number of other healthcare organizations, do not condone the use of placebos in the treatment of patients, believing it is ethically compromising and could undermine a patient’s trust in their doctor. But doctors continue to do it because it is effective. It doesn’t mean these patients weren’t actually sick, just that they found success in treating the ailment via the mind instead of the body—and were unaware of it the whole time.

Neuroscientists at the University Medical Center Hamburg-Eppendorf in Hamburg, Germany, believe that the placebo effect in pain-modulation could be attributed to evolutionary mechanisms that release endorphins from the brain into the spinal cord, thereby temporarily disabling pain mechanisms in the body. 

In their study, a group of patients believed they were testing a pain-relieving gel, with one group told they were getting the real deal, and the others told they were receiving a placebo—when in fact neither were receiving an actual pain reliever. They were both fake. Each group were burned with a hot coil after the gel was applied, only the group that were told they were getting a real drug were given a medium heat, while the group that were told they were getting a fake drug received a much hotter burn. This was repeated several times, and then the groups were tested with the coil set to the same heat level.

When their spinal cords were studied in an fMRI machine, the group that believed they’d received a pain-relieving drug showed less pain activity than the groups that thought they’d been given nothing. 

Dr. Tor Wager of the Cognitive and Affective Neuroscience Lab at the University of Colorado Boulder has conducted several studies surrounding the placebo effect in relation to pain, primarily the idea that you can induce a placebo effect that continues on even after the patient learns their treatment was a placebo. 

“Placebos do seem to depend on your expectations and what you believe,” Wager says. “But if you get this experience over and over again—and possibly the more you sleep on it, where you consolidate memories—the more stamped in it gets. And then it can become decoupled from your expectations, and continue to work on its own.” 

Wager repeated the same hot-coil and fake gel experiment tried in Germany, and found that even after patients learned that they’d been receiving a fake treatment, they still experienced pain relief when the experiment was repeated. Wager believes that once a placebo effect has been experienced over and again, the effect can sometimes remain even without the patient being mislead about the circumstances. 

In some cases, merely the context of a study and a professional doctor can be enough to deliver a desired effect—even when that doctor is telling you straight to your face you’re receiving a placebo. 

In 2010, a group of patients suffering from irritable bowel syndrome were divided into one group who received no treatment at all, and another group given pills clearly marked “Placebo.” The latter group were told to take their pills twice a day. Of those who took nothing, 35% reported a relief from their IBS symptoms; whereas a whopping 59% of those who took the placebos reported relief. 

These situations aren’t just isolated to labs where scientists carefully manipulate the circumstance. Context plays a pivotal role in how we experience all kinds of products. After all, why would we agree to pay twice as much for a drink in a bar as we would a liquor store, if we didn’t believe we would enjoy it more at the bar than we would at home? 

In the Vice report, “Drunken Glory,” an alternative Christian church in Minneapolis provides the experience of getting high on recreational drugs without any actual drugs being ingested. By recreating the context of a drug-taking experience—EDM DJs, raver clothes, and miming the act of smoking a joint, sniffing a line or taking a pill—those who have had multiple experiences taking real drugs in these scenarios are able to recreate the mind and body highs of their preferred drugs, even when they know they aren’t really taking anything.

Anyone in advertising can tell you that it doesn’t always matter how good of a product you are selling, but how you are selling it. From Apple’s snow-white and sanitized steel products, to McDonald’s golden arches, to the testosterone romanticism of the Marlboro Man, the branding narrative we associate with a product informs our experience of it as much as the merits of the product itself.

Once we’re primed to associate and expect this experience a sufficient number of times (especially at a young age) the brain begins to form strong bonds between the memory and the neurochemical mediators that provide an emotion or physical sensation. In the context of a hospital setting, Professor Wager says “it can depend on how you interpret the interpersonal social context: Is the person authoritative? Competent? It can also depend on your background experience, and what experience you’ve had with previous treatment.” 

Wager believes that the growing of information about placebos could undermine the role they play in clinical trials. In most trials, he explains, every group is given a placebo for the first two weeks, and his research shows that often a drug’s impact is somewhat informed by previous experiences with that drug. So whenever they do swap out the fake drugs for the real ones, their data will already be potentially tainted by the placebo effect of nothing—or something totally unexpected—happening.

In the face of this information, anyone who takes any kind of mind-altering substance, whether it be a Snickers bar or an Oxycontin tablet, has to ask themselves: How much of the effect I’m getting from this is derived from my expectations, my previous use of the substance, and what I am told it will do to me? 

For some people, merely posing these questions can lead to anger and defensiveness, the subtext being that they are not being truthful with themselves or others about what is really going on with them. Though, surprisingly, when asked whether his test subjects became upset when it was revealed that they had been misled about the facts of the study, and that their results of feeling less pain were due to a placebo effect and not a real drug, Professor Wager says that no one became upset and were actually happily fascinated by this new information. 

“If you look at placebo studies, the most common story is that people come away with an enhanced sense of their own efficacy,” he explains. “If you can get better without the drug, that’s good news. And some people who learn that can use it as a treatment strategy.” 

For the time being, merely being informed about the potential ability to regulate your own emotional and physical is the only applicable method that placebos can be used as a treatment for anything from drug abuse to chronic pain. Though ultimately, stripping away the pretense of a drug experience can potentially liberate a person from dependency on that drug, so long as this revelation inspires a curiosity for the boundaries of the human mind, rather than a defensiveness about whether or not you’re actually ill. For Tor Wager, these studies have led him to a compulsive questioning about the potential role of a placebo effect in his own life. “How much does it matter if I stress and worry, or if I think positively?” he says. 

“How much does it matter If I believe in my own capacity to self-regulate? This work has convinced me that it does matter, and there are things we can do that help us to manage our own minds. It’s wrong to say [the drugs] don’t matter. It’s wrong to engage in magical thinking. I like to stay somewhere in the middle. It can be dangerous to over-believe that everything is under your control. The way in which things can be ‘all in your head’ doesn’t invalidate the disease that you have, but at times it can be an issue that your brain can have some control over.”

Josiah M. Hesse is a Denver-based journalist covering politics, crime, marijuana, comedy, music, economics and pop culture. His work has appeared in VICE, Noisey, The Cannabist, Splitsider, LaughSpin, and Westword. Follow him on Twitter at @JosiahMHesse or email him at [email protected]

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Josiah M. Hesse is a Denver-based journalist covering politics, crime, marijuana, comedy, music, economics and pop culture. His work has appeared in VICE, Noisey, The Cannabist, Splitsider, LaughSpin, and Westword. Follow him on Twitter at @JosiahMHesse.