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PSY333H5 Lecture Notes - Middle Finger, Headache, Nocebo

Course Code
Terry Borsook

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Placebo Effects September, 20, 2012
- Pain lecture: on Midterm 1
- Power of Suggestion video
- About 30% of people will experience relief from placebo.
Placebo Effect?
- Endogenous pathways: systems built in the body that modulates pain. Placebo
allows these systems to become active to handle pain.
- A lot of the relief that patients experienced was due to placebo (endogenous,
biological, and physiological).
What is a Placebo?
- Acupuncture needles: some individuals are scammed (“sham” treatment”)
because the needles don’t actually go into the skin.
- Past experience with a drug (you take a Tylenol every time you get a headache
- Method of triggering an endogenous effect.
Nocebo Effect
- Side effects, self-reinforcing effect (on the lookout for evidence, confirming
evidence when taking the drug).
In clinical trials
- Actual drug vs. starch drug (ex. acupuncture vs. sham)
- 50% drug, 50% placebo
- Regression toward mean: if you are feeling bad one day, statistically you’ll be
feeling better the second day.
In placebo effect studies
- Placebo pill vs. waitlist
- People on waitlist will get better due to passage of time.
How stuff works: Placebo video
- Drug must beat placebo in 2 trials to be approved by FDA
- When valium is tested in France, it out performs the placebo but in the US the
placebo outperforms valium.
- Drug companies are finding it hard to beat the placebo.
- Meta-analysis (pool many studies together): antidepressants are no better than
placebo (starch/sugar pills)
History of Placebo Effect
- Treading soldiers who had been badly injured
- 38% vs. 83%
- For the soldiers the wound meant that they were going to survive and go home,
the wounds meant freedom.
For civilians the wound meant that they couldn’t do the things they wanted
to, the wound had no redeeming value for them (they felt crippled).
- Just a placebo effect”.
Early Findings
- Loss of oxygen to heart (1994) myocardial ischemia
- 1972: both pills has nothing but starch
- Analgesics: aspirin (just knowing that you have the branded medicine provided
relief). Chemically the same: unbranded & branded medicine.
- Fillers: pharmacologically inert.
Why/how do Placebo effects occur?
- Expectations: that both patients and clinicians have.
- Placebos by injection are more effective.
- Expectations cause systems to start working in the brain that regulate pain.
- Anxiety boosts pain; anything that can reduce anxiety (expectation) can reduce
- Two very different messages but the experience was the same. (Staats. 1998)
- Threshold of pain: when pain starts while hand is in water.
- Tolerance: when they draw their hand cause they can’t take it
When they received positive message, they could tolerate more pain
Pre: Before they received the message.
Verbal Suggestions
- Thoracotomy: open up stomach (serious surgery, a lot of pain).
Natural: given the drug but not told (requested 11.5 mg)
Uncertainty: they got the real drug but told that they might get drug
or placebo. (Requested: 9.2 mg).
Deceptive: told that they were getting drug, telling patient that
they are getting a potent pain killer effect how much they
- Supposedly 3 different analgesics.
- Then implemented conditioning protocol.
Applied heat in varying temperatures
Calibration trials: amount of heat required for that patient to rate
pain at a 6 and then did for a rating of a 2 and 5.
Manipulation: C=6, patients didn’t know temperature changed.
Patients were told: C=control, B=weak, A=powerful pain killer.
Conditioned people into believing this.
Post manipulation: everyone got the same stimulus, 4.
- Placebo effect can be localized
- Asked people their expectations right before test: conscious expectations that A
was a potent pain killer.
Placebo Surgery
- Arthroscopic: 1 inch incisors = supposedly a shorter recovery period
- Lavage: washing the knee
- Debridement: scraping the debris which causes pain.
- Placebo outperformed the two
Bruce Mosseley video
1st patients: removed debris
2nd patients: removed debris and smoothed out the cartilage
- Surgeons earn a lot of money from this surgery so they haven’t stopped doing it.
- Patients told after 2 years that they were in a placebo surgery, why didn’t the pain
return once they were told? (Study didn’t focus on that).
How do expectations work?
- Why would the brain release chemicals after it finds out that it’s getting some
outside means of pain relief?
- Somatic focus: ex: doctor puts medicine in eye and says that you might notice
floaters and you start to notice them.
You notice things that are consistent with your expectations and
start to focus on them.
Geers, et al (2006)
- Conditional: similar to clinical trial, 50% either way
- Table I: unconditional expectation: told about side effects
High attention: pressed button more often
- Conditional expectation: placebo or drug
High attention: patients thought, “I could be feeling this because of
placebo or drug.”
Conditioning/ Experience
- Colloca (2006)
Group 1: comparison group
Group 2: R= red light trial G=green light trial
R= Middle finger, bolt of shock G= much less shock
- Extinction trials: same pain, regardless of stimulus.
Group 3: Block 1: green stimulus didn’t help patients.
Results: Group 2, Block 3: it was through conditioning/ learning
that they experienced/showed less pain in G trials.
Group 3, Block 2 & 3: reported less pain.
Block 4: hard to undo bad experiences.
Prior experience Social
- Group 1: watched a demonstration, reported less pain in green trial than red trial.
Didn’t receive the stimulus themselves but through observation.