Placebo Effects and Pain Discussion Paper

When a patient is prescribed an inactive treatment or substance, yet they experience benefits out of it, then that phenomenon is called a placebo effect. The substance used is called a placebo and this has no medical impact. Placebo is usually given as an injection or as a pill. Even though the placebo does not have any medical utility, it is known to affect the physical and physiological well-being of the people. There have been changes in the heart rate, anxiety levels, pain perception, blood pressure, and even brain activity upon the administration of placebo in people.

The placebo effect is a phenomenon that uses a fake treatment mechanism. The substance that has no medical utility is known as placebo and this can be any inactive component like the distilled water, saline water, or even sugar. Sometimes, all these components, even though they do not have any medical significance can improve the patient’s condition just because the patient believes that it can help them improve their condition. Therefore, the expectation is one of the important factors in the study of the placebo effect. The belief of the person that they are going to get benefits out of this treatment determines the real benefits that they reap out of this process. Scientists usually perform placebo drug trials to separate the influence generated by optimism and other variables from the true treatment value of the drug. Before getting approval from the regulatory authority, all the drugs pass the placebo-controlled drug trials. If the patients are cured upon the administration of the drug than on the placebo effect, then the medicinal product is considered to be real. The placebo effect can be taken as a psychobiological phenomenon which can also lead to different mechanisms. There have been numerous studies on the neurobiological effect of this placebo effect in the field of analgesic and pain. However, recently its effects on depression, motor disorders, and immune systems have also been performed. The placebo effect is a very good phenomenon to learn and understand complex mental activity such as interaction with various neuronal systems in the body and expectancy.

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A placebo’s ability to decrease the pain is well studied by placebo analgesia. It is known to work in two pathways. Either the placebo effect induces the natural pain killers of the brain known as endorphins or the placebo can alter the pain perception of the patient. If prescribed genuine analgesics, the effect has been more in patients than giving them a drug unknowingly. In these conditions, the placebo effect can serve as a supplement along with a genuine drug to cause the effect.

The placebo effect and the brain:

Studies have been conducted by imaging the brain to observe the changes in the neural pattern and activity of people when they are injected with an analgesic placebo. Certain regions need to be observed like the spinal cord, brain stem, and amygdala. During this study, it was observed that they have been a drastic rise in the activity of dopamine and opioid receptors when a strong placebo effect is exhibited by a person. Both of these hormones are involved in motivation and reward pathways of the brain. In contrast to this, there are components known as nocebo that have been found to decrease the activity of opioid and dopamine receptor activity levels. Certain antidepressant drugs are likely to generate neurological changes in certain regions of the brain. This can cause around 50-70% of the placebo effect response inpatient of antidepressant trials.

There have been studies about the measurable changes happening in the neurobiological signaling pathways as a result of placebos in the brain that were observed from the images of the brain. The placebo effect is just not a treatment by inactive components, but also the anticipation that happens around the therapy. For instance- If a person self-medicates himself upon experiencing pain with a sugar pill, the person might not feel better. However, if the person visits a doctor and explains all the symptoms and when the doctor prescribes the same, the person believes the pill to improve things for him or her. This expectation triggers a reward system pathway of the brain and in turn, causes the release of hormones known as endorphins. Endorphins, chemically function like morphine and they can attach to the opioid receptors and brings about relief from the pain. Therefore, it is suggested that in response to the positive expectations, the brain induces itself to generate a set of natural painkillers. This effect can be partially substituted by a chemical known as naloxone that was synthesized for patients who secretes opiates at a larger level like heroin and morphine. Naloxone functions by blocking some of the common opioid receptors in the nervous system and prevents the placebo effect partially. This study showed that the placebo effect can be modulated biochemically to some extent. Patients who have their opioid receptors to be less active do not respond to the placebo effect. In addition to this, people with decreased dopamine metabolism and high levels of dopamine in the brain are more likely to experience a strong placebo effect.

 


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