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If the Doctor Feels Your Pain, Will You Hurt Less?

Posted By Prucia Buscell, Thursday, December 20, 2012

Placebo treatments can have real physiological impact, changing heart rate, blood pressure, chemical reactions in the brain, and influencing how we experience depression, anxiety, fatigue, pain and even some Parkinson's symptoms. Researchers are beginning to learn why, and new findings shed light on the importance of doctor-patient interactions.

Ted Kaptchuk and colleagues at the Program in Placebo Studies and the Therapeutic Encounter (PiPS), the only multi-disciplinary institute devoted to studying placebos, are studying what makes an intervention work when there is no active drug ingredient involved. The researchers, all from the Harvard-affiliated hospitals that created PiPS, are identifying the mechanisms in our brains and bodies that produce the physiological responses. A story by Cara Feinberg in Harvard Magazine tells how Kaptchuk, an assistant professor of medicine at Harvard and an acupuncturist with a degree in Chinese medicine from an institute in Macao, has spent years studying the way people are affected placebos and their delivery. That includes the physical surroundings and the characteristics of the treatment room, the behavior of the doctor, and method of treatment, whether it comes in the form of a pill or needle.

It turns out the placebo effect is actually many effects woven together. For years, placebos have been studied in comparison with real drugs. New research compares different placebos delivered differently. In one study, Kaptchuk divided 270 subjects suffering arm pain into two groups. One group was told that their pain pills might cause nasty side effects, from which they then truly suffered. The other group received acupuncture, and they reported greater pain relief. The unusual element in this study was that both treatments were fake. The pills were cornstarch, and the faux acupuncture needles never punctured the skin. But people thought acupuncture might really help, and they thought those miserable pill side effects would happen.

In another study, Kaptchuk examined the role of doctor-patient interactions in placebo effects. A group of 262 patients with irritable bowel syndrome (IBS) were divided into three groups - one told they were awaiting treatment, one given fake acupuncture with little attention from the practitioner, and a third showered with a doctor's attention as they were given fake acupuncture. The well-tended group experienced the greatest relief. Russell Phillips, director of the Center for Primary Care at Harvard Medical School, says the research points to the importance of the "ritual of medicine" in patient care, and he says that's one finding from the research that doctors can use immediately in their practices.

Kaptchuk doesn't recommend placebos for infections and tumors and he doesn't suggest placebo treatments are ready for clinical application. His interest in the placebo effect was sparked years ago when his acupuncture patients experienced relief even before he started treating them, and he suspected his interactions with them were having something to do with that. His recent researched, published in PlosOne, showed that even patients who knew they were getting placebo IBS treatment experienced twice as much relief as a control group of IBS patients who were not treated. Neuro-imaging of patients' brains has shown that some placebo treatments activate the same brain chemicals that influence sensations of pleasure and reward. The story reports neuroscientist Fabrizio Benedetti from the University of Turin found changes in the electric and metabolic activity in many regions of the brains of depressed patients who received placebos. Researchers have also discovered a genetic component in the susceptibility to placebos, which can be important in designing real drug trials.

No one has fully studied the role that "ritual of medicine" plays in patient care and healing, and Kaptchuk and his team are providing insights on that. The team recently devised an experiment in which fMRIs of physicians brains were recorded as they treated patients.

"Doctors give subtle clues to their patients that neither maybe aware of," Kaptchuk said in the Harvard Magazine story. "They are a key ingredient to the ritual of medicine." Ultimately, he added, the goal is to "transform the art of medicine into the science of care." Read the Harvard Magazine story here.

Tags:  buscell  complexity matters  medicine  neuroscience 

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