Canadian RMT Fall 2016 Canadian RMT Fall 2016 - Page 16

What is the Placebo Effect? J By Brian Fulton Author of The Placebo Effect in Manual Therapy ust mentioning the placebo effect can cause many health professionals to get quite defensive. There is good reason for this- the placebo has had a long and coloured history, including many snake oil salesmen exploiting this phenomenon. It is only within the last 60 years that it has been studied, and only within the last few decades that it has been recognized as an important, inseparable component of the medical encounter. Whether looking at a medical assessment, a simple x-ray, or open heart surgeryi, the placebo (or nocebo) effect comes in to play. If we choose to ignore it, we do so at the patient’s peril, because what you say, how you say it, how you dress, and even the decor of your clinic can either have positive or negative effects on clinical outcomes. Many arguments around the placebo effect involve semantics and turf wars. However, whether one uses terms such 16 as non-specific effects, contextual effects, psychosocial factors, or placebo effect, you are largely speaking about the same thing. The mind has the ability to up-regulate, or down-regulate existing biological pathways. What we are really talking about when examining this subject is the fact that psychosocial factors surrounding the clinical encounter have been shown to affect your client’s course of healing, and their perception of pain. This idea is gaining so much traction as a clinical model that you now see the concept of biopsychosocial model emerging as a more complete way of understanding pain, injury and healing. This new model does not discount the important biological factors at play, but there were too many disparities in the biological model for it to provide a complete explanation. The more that structural abnormality was examined, the more tenuous the connection became between structural issues and pain or dysfunction. ii This is only one of many reasons why the biopsychosocial model is a more inclusive manner of not just understanding, but treating injury, pain and dysfunction. Essence of the Placebo Responseiii A graphic representation of what appears to be going on with the placebo effect can be seen in Figure 1. A psychosocial trigger can up-regulate or down-regulate a biological pathway, which then creates an effect. We see subjective effects such as changes in pain perception and patient descriptions of wellness states, but also objective changes as well. Some of these changes are temporary, but some can last the entire duration of the study. Several systematic reviews in recent years have looked at the role of this phenomenon in manual therapy and authors have overwhelmingly concluded that these effects are ubiquitous. Furthermore, conclusions from these analyses recommend that therapists should Canadian rmt Feature6_Brian.indd 16 2016-08-23 6:30 PM