The Miracle of the Placebo

Dr Vernon Coleman

Pain plays an important part in the defence of our bodies. And yet there are, of course, many times when the pain we experience is of little value. When a pain tells us that something is damaging our bodies we can use it as a warning sign. We can pull away from whatever it is that is doing the damage. But the pain will sometimes continue even when we’ve done everything we can to ensure that no further damage is done. And that type of pain can be both uncomfortable and useless. Indeed, it may even damage us further by weakening our will to live.

However, do not imagine that your body is unaware of the fact that the pain sensations it produces are sometimes debilitating. On the contrary, your body has another system designed specifically to help cope with pain. A separate system is used since the body is thereby provided both with additional flexibility and with an opportunity to maintain the pain sensory endings in a very sensitive state.

The existence of this additional mechanism was first suspected when an army physician noticed that men who had been severely injured often needed only very small doses of pain-relieving drugs. It was also discovered that in many instances quite severe pain could be relieved by tablets and injections with no active pharmacological ingredients.

Now, the existence of something called the placebo effect had been well known since the beginning of the nineteenth century. Traditionally, many doctors had used tablets containing nothing more than starch or lactose in an attempt to obtain some psychological healing effect. The experiences of the Second World War, however, inspired researchers to begin to investigate the whole subject of placebos more closely. Some intriguing results quickly began to appear in the medical journals.

In 1946 Jellineck found that, out of 199 patients who complained of having a headache, no less than 120 got relief from using a placebo. No less than 15 other studies, on a total of 1082 patients, showed that placebos have an effectiveness of something like 35 per cent when given to patients with pains. It was also found that the appearance of the placebo has an effect – in The Journal of Mental Science in 1957 Trouton wrote that, for medical purposes, placebos work best if they are red, yellow or brown in colour, bitter in flavour and either very large or very small. Surgeons discovered that if they opened up patients who had been suffering from angina (chest pain caused by heart disease) and then simply sewed up the wounds again, their patients would make marvellous progress if they were told that they had had bypass surgery. Researchers even found that many patients who take placebos and benefit from them, also suffer from the sort of side-effects that are normally associated with active drugs. In the Journal of the American Medical Association in 1955, Beecher reported no less than 35 different toxic effects suffered by patients taking placebos. In Medical Times in 1963, Pogge noted 38 different types of side-effect. Patients were reported to have become addicted to placebo tablets which contained no active constituents at all.

Many scientists struggled hard to explain all this. Some physicians, puzzled but impressed by the placebo response, seemed convinced that these dummy tablets were working simply because they had a psychological effect on the people who took them. Psychiatrists and psychologists tried to analyse the type of individual likely to respond best to placebos, but they were unable to find any pattern. The only certain factor that could be identified was faith, which seemed to be a vital ingredient. If the patient believed that the placebo would help, then it probably would. If he didn’t believe, then there would probably be no useful effect. A placebo offered by an unenthusiastic nurse had only a 25 per cent response rate. The same placebo offered by an enthusiastic doctor gave success in 70 per cent of cases.

It has been discovered that the placebo response can be explained by physiological activity within the body, rather than by some mysterious and unexplained psychological status. Researchers working in laboratories around the world have become interested in opiate-like chemicals found in the brain. Called endorphins, these chemicals have extraordinary properties. In an article in The Lancet in 1978, Jon D. Levine, Newton C. Gordon and Howard L. Fields of the Departments of Neurology, Physiology and Oral Surgery, respectively, at the University of California in San Francisco not only suggested that the pain-relieving response produced by placebos is generated by the release of endorphins but pointed out that the pain-relieving mechanisms through which morphine and placebos work seem to be similar. They made three observations which supported this association:

1. With repeated use over long periods the pain relief produced by placebos tends to become less effective.
2. Patients using placebos tend to use larger amounts as time goes by.
3. When the placebo is withdrawn patients often show signs of distress.

All these problems are also associated with the use of opiates such as morphine.

Levine, Gordon and Fields argued that, if the type of pain relief that patients obtain with placebos is controlled with endorphins, then an opiate antagonist, normally used to block morphine, should block the placebo effect. The three researchers studies 51 patients, all of whom had impacted wisdom teeth. The results confirmed their hypothesis. As they had suspected, the patients who received the placebo obtained pain relief until they were given the morphine antagonist.

The precise pathways through which this pain-relieving system works are still a mystery. It seems likely that the release of the endorphin, the internal pain reliever, can be triggered by faith and belief. But is seems that there is also an overriding device of outstanding ingenuity which is set to operate when the production of pain, normally a protective mechanism, is likely to put the organism at greater risk than might otherwise be the case.

As I have already explained, feeling pain is often vital to our safety. Normally if you sprain or break your ankle the pain that is produced will stop you walking on it. If you walked on the damaged limb and used the damaged bones and ligaments, you would run the risk of doing permanent harm. The pain protects those structures. However, there are certain circumstances when you would be better off using the damaged limb and risking further damage to it. If, for example, you had twisted your ankle running away from a mugger, you would be in greater danger if you sat down and rested your leg than if you continued to run.

It seems that if the whole organism is threatened, the brain can trigger the release of specific types of endorphin which will dull and override the effect of the pain and enable the individual to use the wounded part of his body. It seems very likely that this release of a pain-suppressing endorphin is triggered when stress levels within the body reach a peak. If so, this phenomenon explains why sportsmen who are injured in important games can often manage to carry on playing with injuries which might normally have crippled them.

Taken from Vernon Coleman’s international bestselling book `Bodypower’ .

Copyright Vernon Coleman November 2021

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