The “gold standard” in scientific research is the randomized, double-blind, placebo controlled study design (RDBPC). [source]
Now, before your eyes cloud over from sheer boredom, there’s something valuable to take away from this.
By the end of this piece, you'll understand how you can get the most powerful, natural pain reliever without spending a dime.
The idea behind the RDBPC, is to take two groups of test subjects, randomize the selection into an experimental group and a control group.
The control group gets something called a placebo. A placebo is considered “inert” meaning it has no viable action, no known way that it could affect the outcome of the study.
However, a placebo has a well known psychosomatic effect. The act of being treated, the manner in which you’re treated and cared for, as well as what you expect to happen, can have a significant positive impact on your outcome.
Unfortunately, a lot of people hear the word placebo and think of it as a sham or fake.
But, a placebo is not something that is fake or doesn’t work. It’s just that it doesn’t work in the same or expected way that the experimental treatment works. A placebo causes us to change how we think, what we believe about something or some situation that, in turn, causes a positive effect.
A placebo is the safest and most powerful natural pain reliever around. No side effects. Inexpensive. No way to overdose.
But some people think that some intervention or treatment isn’t real or isn’t worth doing because it has a placebo effect. It works, but in association with a placebo.
And I’m wondering if that’s really a problem or not. If your mind is powerful enough to influence the outcome of something like a drug (source), then why not include the mind in the treatment?
But there are issues with how some people use the placebo effect.
There are plenty of physical treatment methods that use obtuse language wrapped in a kind of pseudo-science to make it seem intelligent, scientific, and, well, better than something else when in reality, all the wrappings of the approach are doing is setting the stage for a positive outcome.
It's just not okay to suggest that you can, for example, move a cranial or facial bone into a new position and keep it there with a few grams of pressure, when there’s not a stitch of science or basic anatomical information that supports the idea.
My dentist once told me he had gone to a continuing education course to learn how to move facial bones to relieve TMJ pain. He was very excited about what he had learned because it had worked well with some patients and he assumed I knew of it and used it.
He started explaining it and I interrupted him. “Don, there’s no way you can move a facial bone with 5 grams of pressure. You know that. Think about it. What you’re seeing is a change in muscle tone which makes the face look different. And it likely relieves pain because of that change in tone and, well, from your excitement about it and belief in it. Nothing wrong with that but let's not suggest we're moving bones around in a person's face. The bones are in the same place. Besides, if it’s that easy to move facial bones, then my face should be a crooked mess from a nights sleep”.
The thing is, placebos are everywhere and not just in health care or wellness.
Let's take wine for example.
If you spend $150 for a bottle of wine, there's a good chance you will believe and conclude that this wine is better, tastes better, maybe even better for you than a $20 bottle of wine.[source]
And we're not very good at determining if a wine is expensive or not until we have some cues like the packaging or someone telling us it's an expensive wine. [source]
What we believe, as a practitioner or client, has such a powerful effect on outcome, you might think that once you know some procedure's effect is mostly placebo, it wouldn't work or at least not was good as not knowing.
Not the case. [source]
This phenomenon is sometimes referred to as an "open-label placebo". Ted Kaptchuk, MD, is a professor of medicine at Harvard Medical School and director of the Harvard Program in Placebo Studies. Dr. Kaptchuk conducted a study with people who had Irritable Bowel Syndrome (IBS) comparing the effects of a medication and a placebo.
The people who received the placebo, and knew they were receiving it, had significant improvement.
One of the side-effects of "managed care", is the transformation of what was a small scale, personal interaction between a health care practitioner and patient into a higher volume, check-the-boxes and move on interaction.
"Bedside manner" has become almost irrelevant in day-to-day practice yet it's one of the most powerful tools we have to help people (assuming you have a decent bedside manner that is).
Taking the history is a therapeutic event. Unfortunately, most of the time, whoever is taking your history is probably not looking at you but instead a computer screen.
For symptoms that are from self-observation, things like pain and fatigue, a placebo can be very helpful. That, of course, doesn't mean you shouldn't pursue other options as well. But whatever you choose, you have to believe it for it to help you.
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Doug Kelsey has been physical therapist and human movement expert since 1981. He is formerly Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Sciences Center and the author of several books. He has conducted over 250 educational seminars for therapists, trainers, physicians and the public and has presented lectures at national and international scientific and professional conferences. His professional CV is here.