I recently finished reading a great article on scientists studying the application and benefits of the placebo effect. The ‘placebo phenomenon’ can have large positive implications in all medical fields, including physical therapy. Disregarding the knowledge of the placebo effect in fact can be detrimental to our success. Kaptchuk, a leading researcher on the placebo effect says, “its like ignoring a huge chunk of healthcare.” As caregivers, “we should be using every tool in the box.”
So heres Two ways to utilize the placebo phenomenon:
1. Part of the placebo effect is the way we care for the patient.
In their words, “We have to transform the art of medicine into the science of care.”
This was noted in a study that examined multiple sham interventions where one group received sham acupuncture along with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as “very schmaltzy” care (“I’m so glad to meet you”; “I know how difficult this is for you”; “This treatment has excellent results”). Practitioners were also required to touch the hands or shoulders of members of the third group and spend at least 20 seconds lost in thoughtful silence.
What did they find? “The results were not surprising: the patients who experienced the greatest relief were those who received the most care (1-on-1 time, not visits). But in an age of rushed doctor’s visits and packed waiting rooms, it was the first study to show a “dose-dependent response” for a placebo: the more care people got—even if it was fake—the better they tended to fare.”
To take this another way, if a patient shows up late (>15’) then I usually don't like to see them. Why? I ve lost the ability to provide high quality, caring, and educational influence with the patient. Simply, I rather provide no care then crappy care. Losing the time to reinforce posture and patient education and limiting your explanations of interventions can be deal breakers.
Another takeaway for me; in a study looking at post needle soreness following trigger point dry needling they found correlation to their soreness with a higher fear avoidance. Taking the time and explaining the purpose and need of the technique in a sincere and caring manner can go along way towards faster benefits.
2. The placebo effect isn't actually placebo.
What I mean is that just because you can't see change from a mechanical standpoint, doesn’t mean we arent getting significant neurophysiological and psychological gains.
“The first evidence of a physiological basis for the placebo effect appeared in the late 1970s, when researchers studying dental patients found that by chemically blocking the release of endorphins—the brain’s natural pain relievers—scientists could also block the placebo effect. This suggested that placebo treatments spurred chemical responses in the brain that are similar to those of active drugs, a theory borne out two decades later by brain-scan technology. Researchers like neuroscientist Fabrizio Benedetti at the University of Turin have since shown that many neurotransmitters are at work—including chemicals that use the same pathways as opium and marijuana. Studies by other researchers have shown that placebos increase dopamine (a chemical that affects emotions and sensations of pleasure and reward) in the brains of Parkinson’s patients, and patients suffering from depression who’ve been given placebos reveal changes in electrical and metabolic activity in several different regions of the brain.”
“What we ‘placebo neuroscientists’…have learned [is] that therapeutic rituals move a lot of molecules in the patients’ brain, and these molecules are the very same as those activated by the drugs we give in routine clinical practice,”. “In other words, rituals and drugs use the very same biochemical pathways to influence the patient’s brain.”
So when you're using your resets and manual skills, make sure to spend the time letting people know the importance of your reset and maximize the expectations of the procedure. Harrison just wrote about the power of the explanation for spinal manipulation for optimal results. Letting people know they can get better goes a very long way.
