The effect of the pill-"dummy" was comparable to the analgesic effect of the known remedy for migraine.
Recently, one therapeutic agent has become increasingly popular among scientists, which helps to either weaken or even get rid of the symptoms of diseases such as clinical depression, restless legs syndrome, irritable bowel syndrome, erectile dysfunction, etc. And here is one of the freshest articles in the journal Science Translational Medicine, a group of researchers from Harvard Medical School and the Medical Center of Deaconess Beth Israel (USA) reports another ability of this miracle remedy: it cracks down on migraines.
Perhaps it would not be so interesting if it were not for the placebo. The term "placebo" itself appeared at the beginning of the 18th century, but the idea of a drug-free healing effect has existed for many centuries: doctors have long known that for more effective treatment in patients, it is necessary to maintain high morale, optimism and the expectation of a speedy recovery.
However, the use of placebo often met with objections from "medical ethics": after all, whatever one may say, this is a deception of the patient. In addition, for all its merits, this strange psychophysiological effect is not at all omnipotent: you should not expect a placebo to get rid of symptoms that can be called objective (like high blood pressure), and you should not expect that using a placebo can expel an infection from the body. But at the same time, a placebo is able to effectively relieve various types of pain, which largely depends on a person's self-awareness and can be called a subjective symptom - after all, it may really seem to us that something hurts more than it actually does.
In other words, the placebo effect is related to our perception of our own body and health. In this case, the effectiveness of placebo obeys a rather curious pattern. For example, when a placebo was passed off as a muscle relaxant or muscle stimulant, the placebo relaxant was more effective than the placebo stimulant. In another study, it was found that red, yellow and orange "dummy" pills work better if they are passed off as stimulants, while green and blue are better for pseudo-soothing pills. Finally, the size of the pill itself can also affect its effectiveness: large placebo pills work better than small ones.
That said, the neurobiological mechanisms behind the placebo effect remain largely a mystery. Observations of the brain activity that accompanied the intake of the pseudo-anesthetic showed that different areas in the cerebral cortex were triggered in this case than when taking a normal analgesic. Moreover, the areas of the cortex that respond to placebo are related to higher cognitive functions such as memory, attention, etc.
If we return to the last work on placebo and migraine, then the experiment in it was structured as follows: sixty-six volunteers suffering from regular migraines were given envelopes with some pills that they had to take at the next attack. Some received envelopes on which was written "maxalt" (the commercial name of rizatriptan, a well-known headache remedy). Other envelopes were unmarked - and in this case, expectations from the medicine were neutral. Finally, there were envelopes that honestly informed everyone around them that they had placebos. In this case, the person formed negative expectations - after all, he knew in advance that there was no medicine there.
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But at the same time - regardless of the inscription - some envelopes contained real migraine medicine, while others still contained a placebo. That is, as a result, Rami Burstein and his colleagues could compare different combinations between subjective expectations (positive, neutral and negative) and the drug itself (real or dummy). Of course, the scientists proceeded from the self-awareness of the patients, from how the patients felt their pain when taking this or that substance from this or that envelope.
As mentioned above, the placebo has once again proved its effectiveness: if a person drank it under the guise of a real analgesic, then the result was the same as when taking a real analgesic under the guise of a placebo. If the analgesic was taken as it is, then its effectiveness was only twice as high as when it was passed off as a placebo.
That is, positive expectations are quite comparable in strength to the effect of a real medicine. Which, of course, should further push doctors to use placebo in therapy, although this would seem to contradict medical ethics. You just should not, in the first place, overestimate the placebo: it, as has been said, does not work on "real", objective symptoms. And secondly, one should not forget about nocebo - a negative analogue of placebo, which can lead to a worsening of the patient's condition due to the expectation of side effects from the drug, including the imaginary one.
Based on materials from the Medical Center of Deaconess Beth Israel.