Why Placebos Work

 

By Kim Marquardt, RN MSN

This blog post is from the Nurse Kim archives of myth busting. I want to share some "alternative" or maybe just lesser known health and wellness viewpoints for you to chew on.

*These posts are not intended as official medical advice.

They ARE meant to be fun, informative, and thought provoking, hopefully sparking an interest for you to do your own research (you can start with the links I provide!) and discover the marvels of the human body, and how it can function at its optimal performance level if we understand how it works and interacts with our environment and our diet.

I have a passion for health and wellness through lifestyle and nutrition and have done thousands of hours of research in addition to being a registered nurse for 23 years. I have done A LOT of self-experimentation in and around diet, lifestyle, body care, and supplementation and have spent a lot of time looking into the science behind it all (or lack thereof!). Check back weekly for the latest post!

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I want to introduce you to one of my favorite fancy words:

Biopsychosocial

The conceptual framework of Bio-Psycho-Social is that of understanding that every single thing we experience as humans… pain, pleasure, hunger, fullness, illness, wellness, joy, suffering, confusion, understanding, longing, contentment, depression, enlightenment, reality, fantasy… literally EVERYTHING… is grounded in the triad of the biological, psychological, and social (i.e., biopsychosocial) experiences that we inhabit.

The three are never disconnected. Ever.

There is not a single human experience that is only biological, only psychological, or only social, although we often like to neatly tuck things away in these boxes. Our medical professionals certainly do. If your arm hurts, your doctor is going to look at your arm, poke your arm, squeeze your arm, and x-ray your arm. Rarely, if ever, would the provider ask about anything other than the limb itself to determine what might be wrong with your arm.

Why is that a problem you might ask? Seems appropriate under the circumstances, right?

Well… what if you don’t have an arm? Hang with me here.

I’m sure you’ve heard of phantom limb pain in people who have had to have a limb removed or have had an accident that resulted in an amputation. How is it that the person can still experience pain in a limb that is no longer connected to their body?

Phantom limb pain is just one, but certainly one of the most compelling illustrations of why we need to look at the whole person. The biopsychosocial. All the time.

Considering everything contributing to the biopsychosocial experiences of ourselves and others is the only way to ever be truly effective at… well, really anything if we are in the business of interacting with other humans, whether parents, children, partners, siblings, cousins, co-workers, friends, colleagues, customers, managers, subordinates… in any human relationship.

Well… how does the longest intro EVER relate to placebos? So glad you asked.

Placebo

Placebos are one of the most interesting human phenomena in my opinion. The interesting thing being, placebos actually work. Unfortunately, it is considered unethical for a provider of any kind to administer a placebo to a patient in the US. While I totally understand the implications in the modern world, there should be a creative and ethical way we can turn down the pain dial and ease the suffering for another person with a non-invasive, risk-free, scientifically proven method.

Placebos are so powerful in fact, researchers have even done a controlled trial with placebo knee surgery 😮 and found that in “patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic debridement were no better than those after a placebo procedure.”

Umm, WOW? I don’t know whether to be thrilled with the power of placebo or appalled at our (apparent lack of) arthroscopic capabilities. Either way I think it is safe to say that placebo is powerful.

So why is placebo so powerful? Simple.

The biopsychosocial, remember?

Our body, brain, and social systems are connected 100% of the time. This does not ever mean pain or illness is “all in our head,” in fact, quite the opposite. However, it does mean that more than just the affected body part or structure influences how we perceive pain or illness. Remember phantom limb pain?

There is nothing wrong with acknowledging the nuanced, and frankly beautiful, innerworkings of our human experiences. The great news is, understanding that there are complex facets to consider allows us to not be so single threaded when we deal with things like pain, depression, anxiety, etc. We are allowed to explore creative and alternative, perhaps seemingly “unrelated” ways to cope with and manage these things and should do so at every opportunity.

Nocebo

So, what else does all this mean for our everyday lives? Well, as with anything, there is a downside to placebo and that is the opposing phenomena, something called nocebo. As the word itself may illustrate, you can get worsening or exasperation of symptoms through the power of suggestion as well.

Case in point. I was a labor and delivery nurse for 15 years and one of my absolute pet peeves was hearing my patient’s experiences with anyone and everyone telling them their own birth HORROR story! Like… oh look! A pregnant person! I think I will tell them EVERYTHING THAT WENT WRONG when I was pregnant and that will really enrich their life!!

I understand that people are eager to connect in meaningful ways, but really? In fact, when I myself was pregnant, after having been a nurse and hearing about this happening for years, whenever anyone started a sentence with, “When I was pregnant…” I would obnoxiously yell, “NO!” followed by politely explaining that I did not want any undo influence on my own experience… but thanks so much.

Another great habit I adopted as a nurse was asking my co-workers to please not offer me their personal opinion of a patient while giving me report for an oncoming shift. I just wanted the facts, not another nurse’s judgement and synopsis of the patient’s life to affect my own organic experience and relationship with the patient.

And my last and maybe most important pro tip…

One day a co-worker came up to me and eagerly explained in gory detail how another co-worker had ridiculed my outfit, my makeup, my age, my experience, the job I was doing, and pretty much everything else about my general existence. After picking my jaw up off the ground, my focus from the alleged trash talker suddenly shifted to the co-worker staring at me like someone fishing who had just bated a hook and threw it into the water. I took a deep breath and said, “You know what? From now on, if someone says something unkind about me behind my back, please don’t tell me, I don’t want to know.” You could have heard a pin drop. Of course, I still had a stomachache for the rest of the day. There’s that darn biopsychosocial thing again.

In summary

These are some of the most powerful and effective ways I have discovered to mitigate noceboes and invite placebos, understanding that the way we each experience life can be greatly affected and altered by the way we interact together. So, let’s get our biopsychosocial bifocals on and allow ourselves to recognize the many nuanced complexities of our human existence and use that info to enrich our own lives and help others do the same.

Until next week ya’ll!