Summary: According to a new study, placebo sugar pills appear to relieve pain as effectively as medication for almost half of patients who suffer chronic pain. Researchers report those with chronic pain who received sugar pills felt a 30% reduction in symptoms.
Source: Northwestern University.
Someday doctors may prescribe sugar pills for certain chronic pain patients based on their brain anatomy and psychology. And the pills will reduce their pain as effectively as any powerful drug on the market, according to new research.
Northwestern Medicine scientists have shown they can reliably predict which chronic pain patients will respond to a sugar placebo pill based on the patients’ brain anatomy and psychological characteristics.
“Their brain is already tuned to respond,” said senior study author A. Vania Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine. “They have the appropriate psychology and biology that puts them in a cognitive state that as soon as you say, ‘this may make your pain better,’ their pain gets better.”
There’s no need to fool the patient, Apkarian said.
“You can tell them, ‘I’m giving you a drug that has no physiological effect but your brain will respond to it,'” he said. “You don’t need to hide it. There is a biology behind the placebo response.”
The study was published Sept. 12 in Nature Communications.
The findings have three potential benefits:
- Prescribing non-active drugs rather than active drugs. “It’s much better to give someone a non-active drug rather than an active drug and get the same result,” Apkarian said. “Most pharmacological treatments have long-term adverse effects or addictive properties. Placebo becomes as good an option for treatment as any drug we have on the market.”
- Eliminating the placebo effect from drug trials. “Drug trials would need to recruit fewer people, and identifying the physiological effects would be much easier,” Apkarian said. “You’ve taken away a big component of noise in the study.”
- Reduced health care costs. A sugar pill prescription for chronic pain patients would result in vast cost savings for patients and the health care system, Apkarian said.
How the study worked
About 60 chronic back pain patients were randomized into two arms of the study. In one arm, subjects didn’t know if they got the drug or the placebo. Researchers didn’t study the people who got the real drug. The other study arm included people who came to the clinic but didn’t get a placebo or drug. They were the control group.
The individuals whose pain decreased as a result of the sugar pill had a similar brain anatomy and psychological traits. The right side of their emotional brain was larger than the left, and they had a larger cortical sensory area than people who were not responsive to the placebo. The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.
“Clinicians who are treating chronic pain patients should seriously consider that some will get as good a response to a sugar pill as any other drug,” Apkarian said. “They should use it and see the outcome. This opens up a whole new field.”
Funding: This study was funded by National Center for Complementary and Integrative Health grant AT007987 of the National Institutes of Health and the Canadian Institutes of Health Research and Fonds de Recherche Santé Québec.
Source: Marla Paul – Northwestern University
Publisher: Organized by NeuroscienceNews.com.
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Original Research: Open access research for “Brain and psychological determinants of placebo pill response in chronic pain patients” by Etienne Vachon-Presseau, Sara E. Berger, Taha B. Abdullah, Lejian Huang, Guillermo A. Cecchi, James W. Griffith, Thomas J. Schnitzer & A. Vania Apkarian in Nature Communications. Published September 12 2018.
Brain and psychological determinants of placebo pill response in chronic pain patients
The placebo response is universally observed in clinical trials of pain treatments, yet the individual characteristics rendering a patient a ‘placebo responder’ remain unclear. Here, in chronic back pain patients, we demonstrate using MRI and fMRI that the response to placebo ‘analgesic’ pills depends on brain structure and function. Subcortical limbic volume asymmetry, sensorimotor cortical thickness, and functional coupling of prefrontal regions, anterior cingulate, and periaqueductal gray were predictive of response. These neural traits were present before exposure to the pill and most remained stable across treatment and washout periods. Further, psychological traits, including interoceptive awareness and openness, were also predictive of the magnitude of response. These results shed light on psychological, neuroanatomical, and neurophysiological principles determining placebo response in RCTs in chronic pain patients, and they suggest that the long-term beneficial effects of placebo, as observed in clinical settings, are partially predictable.