Hi Guys,
Do you know that you can get an adverse reaction from a placebo? A placebo is an inert substance or therapy that has been shown to have no effect on whatever the researchers are trying to scientifically test, so how is it possible to get a bad reaction, to make you worse, when scientifically it has been proven to have no effect?

Tricky isn't it? Your pessimistic attitude is all that is required to make yourself worse, Martin E.P.Seligman is right after all, optimism is the greatest attitude you can cultivate.

So how do we know, as clinicians, whether the effect we are getting is actually placebo, improvement because of the patients belief, or nocebo, getting worse because of the patients belief?


ScienceDaily: Your source for the latest research news and science breakthroughs -- updated daily
Science Reference
Share Blog
Print Email Bookmark
Nocebo - Placebo

In the strictest sense, a nocebo response is where a drug-trial's subject's symptoms are worsened by the administration of an inert, sham, or dummy (simulator) treatment, called a placebo.
See also:
Health & Medicine

* Pharmacology
* Teen Health
* Tuberculosis

Mind & Brain

* Marijuana
* Addiction
* Illegal Drugs

In its original application, nocebo had a very specific meaning in the medical domains of pharmacology, and nosology, and aetiology.

It was a subject-oriented adjective that was used to label the harmful, injurious, unpleasant or undesirable reactions (or responses) that a subject manifested - thus, nocebo reactions (or nocebo responses) - as a consequence of the administration of an inert, dummy drug, in cases where these responses had not been chemically generated, and were entirely due to the subject's pessimistic belief and expectation that the inert drug in question would produce harmful, injurious, unpleasant or undesirable consequences.

It is also important to remember that in these cases, despite the fact that there is no "real" drug involved, the actual harmful, injurious, unpleasant or undesirable biochemical, physiological, behavioural, emotional and/or cognitive consequences of the administration of the inert drug are very real..

For more information about the topic Nocebo - Placebo, read the full article at Wikipedia.org, or see the following related articles:
Placebo effect — The placebo effect, also known as non-specific effects and the subject-expectancy effect, is the phenomenon that a patient's symptoms can be ... > read more
Experiment — In the scientific method, an experiment is a set of actions and observations, performed in the context of solving a particular problem or question, ... > read more
Belief — Belief is usually defined as a conviction of the truth of a proposition without its verification; therefore a belief is a subjective mental ... > read more
Evidence-based medicine — Evidence-based medicine (EBM) applies the scientific method to medical practice.Using techniques from science, engineering and statistics, such as ... > read more
Note: This page refers to an article that is licensed under the GNU Free Documentation License. It uses material from the article Nocebo - Placebo at Wikipedia.org. See the Wikipedia copyright page for more details.

Cheers

Hi Guys ,
Scientists have discovered the centre for placebo response in the spinal chord. Understanding how,why and in what circumstances placebo works is incredibly difficult at this point in time with such a paucity of research to fall back on. Here is another experiment using placebo.......

New Scientist

Placebo effect caught in the act in spinal nerves

* 14:41 16 October 2009 by Ewen Callaway

The placebo effect is not only real; its ability to deaden pain has been pinpointed to cells in the spinal cord. That raises hopes for new ways of treating conditions such as chronic pain.

The researchers who made the discovery scanned the spinal cords of volunteers while applying painful heat to one arm. Then they rubbed a cream onto the arm and told the volunteers that it contained a painkiller – but in fact it had no active ingredient. Even so, the cream made spinal-cord neural activity linked to pain vanish.

"This type of mechanism has been envisioned for over 40 years for placebo analgesia," says Donald Price, a neuroscientist at the University of Florida in Gainesville, who was not involved in the new study. "This study provides the most direct test of this mechanism to date."

Indeed, the biggest obstacle to establishing the spinal cord's role in placebo pain relief was measuring its activity with fMRI scanning, says Falk Eippert, a neuroscientist at the University Medical Centre Hamburg-Eppendorf in Germany, who led the study.
Squeezing a scan

FMRI scanning has long been used to image the brain, but the part of the spinal cord that Eippert's team was interested in – the dorsal horn – is minuscule in comparison, and so is harder to image. It also swims around in cerebrospinal fluid, further complicating real-time measurement.

The team's first breakthrough was to squeeze an fMRI signal out of the spinal cord. Then they quickly adapted the technique to study placebo pain relief.

This meant telling 13 volunteers a white lie. They were told that the researchers were testing how effective a painkilling cream was, with an inactive cream as a control on the trial.

In fact, neither cream contained anaesthetic. However, when Eippert's team applied the alleged painkilling cream for the first time, they turned down the intensity of painful heat stimulation to 40 per cent of each volunteer's pain threshold – 46 °C on average. When the team tested the alleged control cream, they kept the temperature set at 80 per cent of the pain threshold – an average of 47 °C.

Because of this "fixing" of the temperatures, the volunteers would think, "'OK, this really seems to work, and it will work when I take it the next time,'" Eippert explains.
Feeling the heat

Later, with an fMRI scanner on, the researchers rubbed "control" and "painkiller" creams onto two different spots on each volunteer's left forearm and applied the same level of heat to each spot, 15 times.

The fake "painkiller" cream worked: volunteers said they experienced 26 per cent less pain on the "painkiller"-treated patch of their arm, compared with the "control"-treated area.

Meanwhile, the fMRI scanner witnessed the placebo effect. When skin treated with the "control" cream was heated, an area of the dorsal horn located on the left side of volunteers' lower necks lit up, suggesting increased neural activity there in response to pain. However, this signal disappeared in the "painkiller" trials.

Eippert's team didn't discover what caused this shift. He speculates that higher brain areas involved in buying into the bogus treatment trigger the release of endogenous opioids – chemicals our brain produces that work like opiates and may temper spinal cord activity.

Now that researchers know the neural hallmark of placebo pain relief, they could use it to develop treatments, cognitive or chemical, that take better advantage of belief, Eippert says.

Journal reference: Science, DOI: 10.1126/science.1180142

Cheers

Hi Guys,
Placebo effect continues to confuse forum readers "I am an example of how it works", or " I took it and it fixed my problem" Homoeopathy works via this mechanism for true believers, and even regular medicine gets a huge boost when it is given by a trusted GP, in uniform, in a clinic, where the patient knows the GP has years of university training, if the same medicine was given by a machine with no human to human contact the results would probably be very different, the drug may not work.

Placebo effect is powerful: researcher
Friday, February 19, 2010 - AAP

The placebo effect is both real and "powerful", an Australian researcher says, and it could be harnessed to boost medical care outcomes.

For a decade, Damien Finniss has been studying the mysterious phenomenon, in which dummy treatments are known to have a startling effect on the human body.

"Some placebo responses are tremendously big, they can be as equal as an active drug," Mr Finniss, of the University of Sydney's Pain Management and Research Institute, told AAP.

"It's as simple as belief and expectancy, and trust in the doctor."

Mr Finniss conducted a review of the global pool of research into the placebo effect for a paper published in The Lancet.

The first references to phenomenon can be traced back through the medical literature to the 1700s, though it did not become a topic for serious study until the 1950s.

He said it was now increasingly seen as a promising target for research into the interaction between the mind and the chemical processes of the brain.

"To some it has been controversial ... other people have seen that it is something that has merit, is powerful and can be used in a clinical setting," Mr Finniss also said.

The review highlighted research that shows the placebo effect in action, and how it comes in a variety of forms.

One study involved people who were taking opioid-based pain killers and who were then switched unknowingly onto a placebo.

The participants continued to report a benefit from the dummy pills, and this was confirmed by brain scans.

"Areas in the brain rich in opioid receptors become activated to a placebo," Mr Finniss said.

"The brain changes to the placebo are very similar to real changes to opioid analgesics".

Similar tests have been done with a different type of pain killer - non-steroidal anti-inflammatory drugs (NSAIDs) - which take affect in a different part of the brain.

The switch to a placebo again resulted in chemical changes only in the part of the brain where NSAIDs take effect.

"Advanced technology and research methodology has identified different placebo effects across the body, such as placebo-induced changes in heart, lung and hormone function," Mr Finniss said.

Another study showed how treating patients via an automated process - such as having a pain killer administered via a computerised pump - could make potent drugs "significantly less effective".

Participants would respond normally to the same dose when it was administered by a doctor, Mr Finniss said.

This showed how personalised medical care along could prompt a placebo effect.

"You don't have to give a placebo to get a placebo effect," Mr Finniss said.

"And therefore, ethically, we should be learning about the other component of (placebo effect in) normal medical practise and enhancing it so we can improve outcomes."


Cheers