To relieve, not to cure

Before you allow in clinical practice a new drug or therapy they are tested. It is long and difficult: for example, the new drug the drug test first “in vitro” (in vitro), then in laboratory animals and then on humans. At some stage you have to do the paperwork, to speak to the ethics committees, write research papers.

Checking the effectiveness in vivo, it is necessary to find out: not deadly treatment, what side effects it may cause (and is it possible from them to painlessly), and also does not explain whether his action to some other factors. To assess the latter helps placebo pill dummy, saline, “empty” electrical stimulation and all that simulates the treatment, but does not lead to any changes in the pathophysiology.

Sometimes it turns out that this simulation leads to unexpected results, which tell scientists that they developed a therapy that something is wrong. Simply put, sometimes placebos work — and no worse (and maybe better) than active drug: patients with chronic pain to the time pain, patients with depression feel better, and forever complaining of migraine-back to normal.

It should immediately clarify that, in itself, a placebo does nothing (on it and a placebo): the dummy has no direct effect on the pathophysiology of the disease or disorder. It is completely due to the “placebo effect”, and the most he can do is to alleviate any symptoms or, in the case of the effect of nocebo, on the contrary, to call them out.

Why it works

The nature of the placebo effect is still not known until the end. It is clear that the effect is not exactly boils down to one simple biological or psychological mechanism, and has comprehensive feasibility study — for example, one of the most respected researchers placebo Kapchuk Ted (Ted Kapchuk) from Harvard University calls a placebo effect biopsychosocial.

A few years ago, for example, scientists have foundthat relief of chronic pain after taking the placebo possible to predict on the activity of the middle frontal gyrus in the right hemisphere of a person, the same as the analgesic effect of the antidepressant uoxetine. It has some biological component of the effect is.

With regard to other factors, then, on the one hand, work the expectations of the patient from receiving treatment: if he sees that his trying to cure, it will work, even a dummy, and sometimes even if he knows it’s a dummy (but more on that later). On the other hand, the placebo effect is considered a manifestation of a conditioned reflex to the attention of doctors: treatment helps, even if a drug is fake.

Dummy pain and depression

Over the years, studies of the placebo effect was highlighted in a number of diseases and disorders, against the symptoms which pacifiers can help. So, the placebo effect is well manifests itself against chronic pain — sometimes working no worse than classic pain. This is partly due to the fact that pain is a feeling, and therefore lends itself not only physiological, but also psychological manipulation.

The existence of a physiological effect of placebo analgesia is confirmed, there are descriptions of its mechanism. For example, studies showthat the analgesic placebo effect is reduced if you give the patient naloxone — a substance that blocks the action of opioids: diazepam, morphine, heroin. Naloxone is an antagonist of opioid receptors in the nervous system, it binds with them and not let to receptor opioids. And while “the pacifier” with opioid receptors to communicate nothing, and thus, naloxone did not prevent anything, he, however, prevents this anything to relieve the pain of the patient.

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