Holistic medicine

Placebo effect: explanation and application


If people believe that therapy cures their disease and their condition really improves, even though the treatment has no scientific effect, we speak of a placebo effect. This is the case, for example, if a tablet taken contains no medically effective substances and the patient still feels an improvement in the symptoms after taking it.

This placebo effect has been demonstrated in various studies. Today we know that in such situations the body provides the affected with neurotransmitters and hormones - the belief in the effect of an ineffective treatment triggers a self-healing reaction of the body.

Conversely, there is also the nocebo effect: Those who are convinced that a treatment, a medication or an operation has bad effects, in which the pain increases, the healing is delayed, or the symptoms even worsen.

How does the placebo effect work?

Today neuromedicine can explain how the placebo effect relieves pain: We do not immediately feel pain in an injured area, but the peripheral nervous system and the spinal cord send the information "pain" to the brain. The brain has a pain memory. That means: Depending on how we are conditioned, the brain classifies pain as stronger or weaker.

The body can produce and release hormones and neurotransmitters that regulate the “pain” signal. The body's own opioids are linked to the same switching points as artificial pain relievers. The happiness hormone dopamine can be triggered by the placebo effect; Cholecystokinin, on the other hand, triggers fear and is released by the nocebo effect.

Usually the pain develops on the wound and the information travels to the brain in a very short time, which responds to the pain. In contrast, in the placebo, the brain region of the prefrontal cortex expects pain relief. Therefore, it sends signals to those areas of the brain where the opioids are formed. Those affected do not suppress the pain, but actually alleviate it with the power of their thoughts.

Sham operations and pill size

Even sham operations work for some people. With pseudo drugs, many small pills work better than one large one. And the same rule applies as for branded products: the more expensive ineffective pills are, the higher people rate their effectiveness.

Placebos also have a negative effect. For example, people choked out their stomach contents after taking an alleged emetic.

The emotional brain

Neurologist David Servan-Schreiber suspects that more than half of all visits to the doctor are caused by stress, and the majority of all medications in western countries are used to relieve stress-related symptoms: antidepressants, sedatives, antacids for heartburn, medicines for high blood pressure or high cholesterol. Alcohol is also a means of dealing with stress and depression.

The limbic system in the brain regulates the emotions, and with it the almond kernel from which fear reactions originated. This “emotional brain” controls heart function, blood pressure, hormones, the digestive and immune systems, breathing, appetite, sleep and libido. The “killer cells” of the immune system would also be controlled by the emotional brain. So while positive emotions like relaxation or well-being activated them, fear, stress and depression would inhibit them.

This emotional brain has the ability to heal the body itself, and it can be “programmed” to do so, Servan-Schreiber said. Well-known methods can also be used for programming: the stings of acupuncture needles would deactivate the pain centers.

The neuroscientist Benedetti says: "The interaction with the doctor, the environment of the doctor's office or the clinic with its typical smells and noises - all of these are powerful sensory stimuli that the patient associates with a therapeutic action."

Two phases of pain

The placebo effect runs in two phases: first, expectation and second, learned reaction. First, the network takes action, which prevents the pain stimulus from reaching the brain; then it slows down the activity of pain-processing brain regions.

There is not a placebo effect, but various ones, according to Benedetti, and it depends on the previous conditioning which biochemical mechanisms took place. For example, a placebo pain reliever releases various neurotransmitters, depending on which analgesic (pain reliever) the patient would have received previously - if the patients were used to morphine, the body emitted opioids. In people with Parkinson's, free dopamine in the body increases by up to two hundred percent when they use placebos.

Placebo effect increases the effect of real medication

Benedetti also examined how the stimuli of medical treatment influence the effects of medication. Patients with postoperative pain received analgesics (pain relievers) either openly from a doctor or concealed via a computer-controlled injection pump. The result was clear: with all painkillers tested, the effect of the concealed injection was weaker.

According to Benedetti, the expectation of messenger substances is already released with the open injection, and these occupy the same receptors as the analgesics. That was also the case in time: with the medical injection, the pain was relieved immediately, with the concealed one it took much longer. Benedetti's experiments could be used to test when drugs are pharmacological and when they are psychological.

Doctors and the placebo effect

Scientists at the Institute for Medical Psychology specifically use the placebo effect. For example, the doctor Karin Meissner, who is a scientist, is aware that objectively, acupuncture is of little use, but still successfully uses it to treat symptoms such as hay fever.

Studies at the institute showed that it does not matter whether doctors place the needles according to the "energy meridians" of traditional Chinese medicine or whether they are distributed without a pattern on the skin. The result stunned: the needles worked in both cases. Meissner explains this with the placebo effect. This was how the patient's expectations and circumstances, such as the trust and calming words of the doctor, worked.

The American medical professor Ted Kaptchuk gave patients placebo pills for irritable bowel syndrome in 2010 and even informed them beforehand that they were placebo. Nevertheless, the symptoms of those treated with placebos improved significantly compared to those who received no treatment at all.

Doctors, psychologists and neurobiologists therefore rely on involving and educating patients. The neurologist Ulrike Bingel says: "The patient must understand the meaning of therapy." So instead of giving people affected placebos without them knowing about it, doctors should explain to them that they are placebos, like the brain messenger substances and It produces hormones and why the positive attitude of the sick affects the outcome.

The American doctor Jo Marchant considers such self-healing to be more successful the more a person imagines his healing. For example, he could literally imagine how a wound closes, how knee pain ends or how he can walk again. Shamans worldwide also teach such precise healing images.

Another factor is trust in the doctor treating you. Therefore, patients should rely on their “gut feeling”. If someone from a group of friends trusts a doctor, it is transferred to those affected because the brain does not differentiate between their own experiences and information from other people. If friends or relatives support the patient, this promotes the placebo effect. The brain then releases oxytocin, a binding hormone.

With placebo drugs, but also with drugs that actually work chemically, the effect increases through rituals. This can mean taking “medicine” at the same time at the same place, using a certain glass for rinsing, or even a “solemn” act to create it.

Homeopathy and placebo effect

A common example of the placebo effect is homeopathy. Here substances are diluted to such an extent that, from a chemical point of view, they are no longer available from a certain potency. Critics of homeopathy attribute the success in curing diseases to the placebo effect. A reproach that practicing homeopaths vigorously contradict, even though a therapeutic application of the placebo effect may seem reasonable.

Homeopaths take their time, listen and respond to the individual complaints of their patients. It is a special setting, which in the best case also includes a good and trusting relationship between the practitioner and the person concerned, supplemented by the belief in the effects of homeopathy. One could say critically that the procedure consists of an unstructured talk therapy plus placebos. The question is whether the globules are not a symbolic medium that only brings communication between homeopath and patient, such as the release of hormones and neurotransmitters, into flux.

An old story

Hippocrates already used placebos in ancient times, methods that he knew were ineffective; Shamans stage a magical theater in which they conjure up foreign bodies that are said to cause the disease in the bodies of the people concerned and which they remove with “mental operations”.

Some abuse their fellow human beings' beliefs to charlatanize; Usually, the healers of traditional cultures do not behave differently from today's doctors, who know how the white coat, a gentle voice and associations with the hospital can contribute to healing.

Military physician Henry Beecher put the placebos on a scientific footing in World War II after watching a nurse inject saline instead of morphine, and yet those affected were doing better. Beecher also inspired the double-blind studies that we use today to determine the effectiveness of medicines. The test participants do not know whether they are receiving real medication or pseudomedicine.

Placebos for phobias

Placebos work extremely well against phobias because they form in the brain and can be changed by positive suggestions. For example, 34 women with excessive disgust before spiders underwent a study in which they allegedly received Angostura, a medicine from South America. In reality, they were consuming pure silica. All subjects felt much less disgust with spiders after the placebo than without the dummy.

Researchers are now planning to use placebos as a first step in psychotherapy for phobias, in particular to show patients how effective their self-healing is in overcoming the symptoms.

Religious ritual and placebo

Hindus cleanse themselves ritually in the Ganges, which in “holy cities” like Vahranassi, the city of the god Shiva, is chemically a sewer. From a purely logical point of view, a bath in the water of the Ganges should lead to various infectious diseases rather than cure people. However, the hope that prayers and ritual acts are helpful leads to the release of hormones and messenger substances, as does the belief in the effectiveness of a placebo pill. A study at Georgetown University showed that belief in supernatural help accelerated healing in 75 percent of patients.

This positive self-suggestion applies to many areas of life. If I believe that the woman of my heart loves me too, that alone creates positive emotions, even if it is not the truth. This also applies if I believe that a kind God loves me and will hug me after my death.

This anti-realism in religions could be described as a placebo for everyday life: whether someone prays to the rain god that the harvest does not wither or thinks that God will stand by him when he undergoes heart surgery and believes that it is a positive one Gives meaning in life. These are all self-suggestions that can lead to the body producing the appropriate opioids and hormones.

Religion cannot be reduced to the alleviated alleviation of pain, but it does play a significant role. It is no coincidence that Christians ask the Lord's Prayer “and deliver us from evil”, and the goal of Buddhism is to overcome suffering in life. A crucial lesson in Buddhism is to accept pain instead of fighting it mentally. This could be described as reducing pain awareness, which in turn is a classic placebo.

Suffering is the core of Christianity. The crucified Savior took on the sins of mankind and their pain, and Apostle Paul taught: “We suffer, but not like others who have no hope.” Faith itself, and no supernatural power, relieves the pain. It can also be understood that people find faith in bad phases of stress, whether a fourteen-year-old begins to believe in God while her mother is in the clinic with cancer, or a drug addict sees his last chance in religion .

Such placebo effects are obviously greater the more fundamentalist a person practices his religion. Moderate Christians who accept scientific theories therefore produce less of the body's pain suppressants than fanatics who insist that miracles happen. Conversely, this spiritual enthusiasm also leads to deep despair when an expected miracle does not come true.

Is there also a rational alternative to religion to use the power of the placebo over physical and emotional pain? That should be difficult, because self-suggestion works better, the less those affected know that it is a suggestion. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch

Swell:

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  • Jens Gaab, Joe Kossowsky, Ulrike Ehlert, u.a .: Effects and Components of Placebos with a Psychological Treatment Rationale - Three Randomized-Controlled Studies, Scientific Reports, 2019, nature.com
  • Carvalho, Cláudia; Caetano, Joaquim Machado; Cunha, Lidia; u.a .: Open-label placebo treatment in chronic low back pain a randomized controlled trial, PAIN, 2016, Volume 157, Issue 12, journals.lww.com
  • Regine Klinger: Placebo analgesia - fascination with the body's own pain inhibition, Deutsche Paingesellschaft e.V. (accessed: 18.09.2019), dgss.org
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Video: Making Sense of the Placebo Effect. Q and A with Ted Kaptchuk (December 2021).