Sugar pills or a simple placebo to relieve pain in some chronic pain patients? It would seem that it is effective for a part of the patients, conclude these researchers from Chicago: “Placebo pills relieve pain as effectively as drugs for half of the patients suffering from chronic pain and in this case their pain is reduced by 30% ". Data presented in Nature Communications, to be taken with a grain of salt.
Especially, as the authors write in their press release, there is no need to deceive patients, the brain is ready to respond. Nevertheless, not all patients would respond to the placebo, it would be a question of targeting certain patients according to their brain anatomy and psychology.
Patients whose brains are wired to respond: Scientists at Northwestern Medicine show here that it is indeed possible to identify or reliably predict which chronic pain patients will respond to a placebo pill. The study's lead author, Dr. A. Vania Apkarian, a professor of physiology at the Feinberg School of Medicine, says, "These patients have the appropriate psychology and biology that puts them in a cognitive state such that as soon as the doctor says "this treatment can reduce your pain", their pain is reduced".
No need to “trick” the patient: the doctor can explain to the patient: “I am giving you a drug with no physiological effect, but your brain will respond to it”. Needless to hide it, there is – write the authors – “a biology behind the placebo response”.
Considerable advantages , if this hypothesis were validated…:
- Prescribe non-active drugs rather than active drugs and avoid long-term harmful and addictive effects (eg opioids). The placebo then becomes a therapeutic option in the same way as the drugs currently available;
- Eliminate the placebo effect of drug trials and better identify the physiological effects of candidates, eliminating much of the “background noise”;
- Reduce healthcare costs…
“Too good to be true” results?
This randomized, blinded trial of approximately 60 patients with chronic back pain, divided into 2 groups, drug-placebo finds that placebo-responsive participants have similar brain anatomy and psychological traits. The right side of their emotional brain is larger than the left, and their cortical sensory area was larger than that of placebo nonresponders. These respondents also turn out to be more highly aware of their emotions and their environment and more sensitive to painful situations.
According to the authors, there is therefore a real response with a measurable reduction in pain in these placebo-responsive patients: "Clinicians treating patients with chronic pain must seriously consider that some will respond as well to a placebo pill as to any other medication.
According to the patients, should the placebo be tested?