How Placebo Pills Are Helping Patients With Chronic Pain

Placebo Pill StudyNew research suggests that knowingly taking placebo pills may help chronic pain sufferers find some pain relief.

Conventional wisdom suggests that the placebo effect should only work if the patient believes they are taking a medication with an active ingredient, but the new study suggests that may not be the case.

“These findings turn our understanding of the placebo effect on its head,” said joint senior author Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School. “This new research demonstrates that the placebo effect is not necessarily elicited by patients’ conscious expectation that they are getting an active medicine, as long thought. Taking a pill in the context of a patient-clinician relationship — even if you know it’s a placebo — is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms.”

Placebo Study

For the study, researchers recruited 97 individuals with chronic low back pain and split them into two groups. Both groups watched a 15-minute video explaining the placebo effect, then one group continued their normal treatment, while the other group took daily placebo pills that were stored in a container marked “placebo pills” that clearly stated that they had no active ingredient. Both groups continued their specific treatment options for three weeks.

At the end of the three week period, patients in the placebo pill group reported 30 percent reductions in typical and maximum pain, while those in the treatment as usual group experienced 9 and 16 percent reductions respectively. Individuals in the placebo group also reported a 29 percent drop in pain-related disability, while those in the treatment as usual group did not report improvement in that measure.

“Our findings demonstrate the placebo effect can be elicited without deception,” said lead author, Claudia Carvalho, PhD. “Patients were interested in what would happen and enjoyed this novel approach to their pain. They felt empowered.”

However, Dr. Carvalho cautioned that the placebo effect may only provide mild relief for patients with undiagnosed chronic back pain, and that patients with specific conditions like herniated discs or pinched nerves will not experience similar results.

“You’re never going to shrink a tumor or unclog an artery with placebo intervention,” he said. “It’s not a cure-all, but it makes people feel better, for sure. Our lab is saying you can’t throw the placebo into the trash can. It has clinical meaning, it’s statically significant, and it relieves patients. It’s essential to what medicine means.”

Yoga And Acupuncture May Ease Chronic Pain Symptoms

Yoga Chronic Pain MinnesotaNew research published in the journal Mayo Clinic Proceedings suggests that activities like yoga, Tai Chi and other complementary health approaches may help alleviate discomfort associated with some types of chronic pain.

Lead author Richard L. Nahin, Ph.D., of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH), suggested that activity options like Tai Chi and yoga may help prevent symptoms from chronic pain, especially when paired with other treatment options like regular exercise, a healthy diet and certain pain medications.

“For many Americans who suffer from chronic pain, medications may not completely relieve pain and can produce unwanted side effects,” said Nahin. “As a result, many people may turn to non-drug approaches to help manage their pain.”

Chronic Pain, Yoga and Tai Chi

For their study, researchers identified 150 randomized, controlled U.S. clinical trials conducted over the past 50 years that examined non-drug approaches to chronic pain. Specifically, the research targeted five common sources of pain, which were:

The treatment techniques analyzed were considered effective if patients reported that it led to improvements in pain severity and pain-related disability/function. After looking at the data, researchers found that both yoga and acupuncture were safe and effective for chronic back pain, while Tai Chi and acupuncture may be most beneficial for patients with osteoarthritis of the knee. Massage therapy was also somewhat beneficial for patients suffering from neck pain when it was managed with one-hour sessions 2-3 times per week.

“These data can equip providers and patients with the information they need to have informed conversations regarding nondrug approaches for treatment of specific pain conditions,” said David Shurtleff, Ph.D., deputy director of NCCIH. “It’s important that continued research explores how these approaches actually work and whether these findings apply broadly in diverse clinical settings and patient populations.”

At the end of the day, the study paints an interesting picture at some non-drug techniques that can be used in conjunction with other lifestyle interventions to provide relief. Simply getting massages or doing some yoga isn’t going to fully rid you of your pain, but it can play an important role in a total pain management plan. There is no magic pill to cure many of the above conditions, but with a multifaceted approach that involves treatment with a physical medicine pain specialist, relief can be found.

The Link Between Anxiety and Chronic Pain

Anxiety and chronic pain minnesotaResearchers say the expression of a single peptide has been linked to both anxiety disorders and chronic pain, suggesting that we may be on the verge of a breakthrough for treating patients with both conditions.

Currently far too many patients are being prescribed a combination of drugs to treat both their anxiety and chronic pain condition, which researchers say can be dangerous. Instead, researchers say the discovery of the expression of pituitary adenylate cyclase activating polypeptide, or PACAP for short, could change the way we simultaneously treat the two conditions.

“Chronic pain and anxiety-related disorders frequently go hand-in-hand,” said Dr. Victor May, a professor of neurological sciences at the University of Vermont and study author.

Chronic Pain and Anxiety Disorders

For the study, researchers used mice to determine where the pathways for stress and pain intercept. By applying what the team called a “PACAP receptor antagonist,” researchers were able to successfully reduce both stress and pain in the rodents.

“By targeting this regulator and pathway, we have opportunities to block both chronic pain and anxiety disorders,” said May, who plans to next develop small molecule compounds that can antagonize PACAP actions. “This would be a completely different approach to using benzodiazepine and opioids — it’s another tool in the arsenal to battle chronic pain and stress-related behavioral disorders.”

The findings are intriguing because the US Food and Drug Administration recently issued a strong warning against mixing opioid painkillers and benzodiazepines, which is a current standard treatment for patients with chronic pain and anxiety. You can read more about the study here.

Fibromyalgia: A Real Disease

Fibromyalgia minnesota pain careFibromyalgia is a syndrome that causes diffuse pain throughout the body. Unfortunately, many practitioners still believe it is strictly a psychological disorder and many of the patients are faking symptoms. New research has now been finding objective changes that correlate to the symptoms in fibromyalgia. These findings however are not leading to tests to prove whether a person does or does not have the syndrome.

Diffuse whole body pain with muscle tenderness, abdominal complaints, headaches, fatigue, and sleep issues all are prominent characteristics of fibromyalgia. Currently, the diagnosis is made by history and exam of a patient, then by excluding other diseases such as diabetes, thyroid dysfunction and rheumatoid arthritis. The disease is much more common in females and first becomes symptomatic in the mid- to late-twenties but sometimes as late as the fifties to early sixties. The severity can be highly variable, from mild to disabling. Treatment is basically symptomatic at this time.

New Fibromyalgia Research

Dr. Anne Louise Oaklander of Massachusetts General Hospital studied 27 patients with fibromyalgia as diagnosed with the American College of Rheumatology criteria of the disease, and used a group of 30 matched control subjects. Skin biopsies were taken of the lower leg and 41% of the patients met the criteria of small fiber polyneuropathy. Her team also studied a group of 41 patients who had fibromyalgia begining as a juvenile, and 59% of those had small fiber polyneuropathy as diagnosed with a skin biopsy. Further study of these same patients indicate some of them appeared to have an immune component, like those with rheumatoid or lupus arthritis, and when treated similarly they improved in symptoms. Small fiber polyneuropathy is also seen in diabetes and vascular disease and is associated with the pain these patients experience. Unfortunately, the definitive test for this type of neuropathy is a biopsy (which is a removal of a small patch of skin) and microscopically examining it for nerve fiber endings, which is quite complex.

The importance of this study is that these findings indicate that there is real pathology behind fibromyalgia. It is not psychosomatic or imaginary. It also makes the disease more understandable. The small nerve fibers are those that carry pain sensations. If these fibers are abnormal, the result is pain. These fibers exist throughout the body, in the limbs one would have muscle pain, in the head one would get headaches, and in the trunk one might have stomach problems.

Small fiber neuropathy and peripheral neuropathy are currently best treated with medications that affect nerve cell function. The common medications, know as neuropathics, including gabapentin, Lyrica, Cymbalta, some other antidepressants, and a few miscellaneous medications are helpful. Opioids are very poor medications for this and help very little if at all. Fibromyalgia seems to respond in a similar way, and if it is a small fiber neuropathy, the same treatments would be beneficial.

Improving the understanding of the cause of fibromyalgia and the changes that exist in the body hopefully will lead to better treatment.  Not all patients with fibromyalgia have these findings of small fiber neuropathy on biopsy. This syndrome may have different causes, and the treatment may vary due to these differences. Knowing that about half of the patients at least probably have small fiber neuropathy allows physicians to focus treatments that are effective for these problems. Further, the youngest patients with fibromyalgia commonly have immune system dysfunction and treatment for these disorders has also been showing promise. Fibromyalgia is slowly moving from a “psychological” problem to an objective medical syndrome with definitive findings.

Chronic Pain and Depression

Chronic Pain DepressionThe majority of people will deal with chronic or nagging pain at some point in their life, and new estimates suggest that 1 in 10 adults will be diagnosed with chronic pain every year. Even though these numbers are really high, as a society, we’re not doing a very good job of solving the problem of chronic pain.

Even when chronic pain is managed and controlled, it can lead to other issues. When you’re constantly dealing with physical pain, it can be mentally and emotionally exhausting, and the same can be said in the inverse. If you aren’t in the right mindset, it can be difficult to stay active and really work towards preventing chronic pain.

Recently, a new study decided to take a closer look at the connection between chronic pain and mental health – more specifically, depression and chronic pain. For their study, researchers out of the University of Edinburgh in the United Kingdom examined physical and mental health assessments of more than 100,000 individuals.

Depression and Pain

After looking at the findings, researchers uncovered:

  • People who have partners with depression were more likely to experience chronic pain.
  • A person whose spouse was depressed had an 18.7 percent increased risk of suffering from chronic pain.
  • Also of note, having a parent with chronic pain increased a person’s likelihood of developing chronic pain by 38.4 percent.

“We hope our research will encourage people to think about the relationship between chronic pain and depression and whether physical and mental illnesses are as separate as some believe,” researchers wrote.

At the end of the day, this research shines a little more light on another potential avenue for chronic pain management. Sometimes we need to go beyond the root source of the pain and look at environmental and other contributing factors. If we can improve our mental health and the mental mindset of those around us, we might be able to reduce the number of people who have to battle chronic pain on a daily basis.