Can I Create Placebo Conditions to Reduce My Pain?

This is a great summary of how we came to be aware of the placebo effect. The word “Placebo” comes from the latin "I shall please" and has historically meant "any medicine adapted more to please than to benefit the patient." The weird thing about persistent pain is that placebos work. They both please and benefit the patient.

To appreciate how this can happen we first need to understand how pain works.

We don’t have a pain centre in our brain instead we have many systems that can become linked. Like a spiderweb if any part of the system is triggered the vibration is felt in the whole. Once the danger messages reach a threshold then a series of chemical and hormonal reactions takes place. Stress hormone and prostaglandin production increases, dopamine and oxytocin production decrease and pain is created.

Placebos create a strong message of safety in our mind. If the safety messaging can overpower the danger messages then the brain will stop sending pain signals to the body. The brain will then trigger a healing cascade of chemicals. It will increase its production of dopamine, oxytocin and endorphins along with our natural opioids. The stress response will dial down and the body will relax back into our rest and digest state.

The most effective placebos are:

• Prescribed by expensive, slick experts who listen to you and believe you.

• They are backed by others opinions, they might have five star reviews that enthusiastically endorse their treatment

• The packaging, colour, size and taste all count too. Red, yellow, and orange pills are associated with a stimulant effect, while blue and green are related to a tranquillising effect.

• Their branding and product design is clinical, medical and science-y looking.

• For greater effect, the process must be less pleasant. Sham surgery or injected placebo are just as effective as actual surgery or injected pain relief.  

• Routine is important: they work better when taken at the same time each day.

• They give the patient a sense of control over the situation (This is why we have elevator lights, computer progress bars, and pedestrian lights).

• Though you need to take action with an expectation of healing, open placebo trials are successful too. This means that people know they are taking a placebo and they still get better (as seen in the study below)

So? How can we create a placebo situation for our pain?

1)We can buy placebo pills and commit to taking them at the same time each day. There are lots of places that sell placebos. I have used homeopathy for my kids for years but you can now get open placebo pills online, here's one example.

2) If you have period pain and want to pay £450 for a device that satisfies most of the above criteria then you could try this headband?

3) Because we are targeting the central nervous system using a TENS machine every day for a week is worth trying. It may be placebo. It may be updating the brain's information on the sore body part. People aren't sure. It works for many patients and doesn't come with side effects.

4) You can book in a session with a friend (or me) to have them listen compassionately to your pain story. Another term that people now use for the placebo effect is the "meaning" response. This recognises that the therapeutic context helps to make people feel safe. Make sure that your friend takes notes and asks follow up questions.

5) Print out a treatment plan and put it on your fridge, ask someone to keep you accountable to it. Get them to follow up weekly. A plan gives a path to improvement. Decide which exercises to do. Choose the intensity you will work at. Have a flare up plan, maybe even have a box or basket filled with things that you will need when the pain next flares. Identify tasks that are possible even when the pain is bad.

6) Challenge expectations or beliefs that you hold about your pain. For example “I can’t walk up the stairs it will hurt” change that belief incrementally - I can walk up one stair pain free. I can walk up two stairs pain free and so on.

7) When doing movements that hurt, repeat to yourself “smooth fluid easy” hear yourself saying the words, these are the desired state of your movement. Our minds listen to the words we say and it responds. Even when we're wrong. The saying

"cells that fire together wire together" means that we create neural paths that connect words with situations. If we want strong positive pathways then we need to speak positively about things that matter. Negative words reinforce danger messages to the brain.

8) Target your visual system by either mentally rehearsing a movement before you do it or by visualising your pain shrinking. When we mentally rehearse the movements that we want to do, the same area of the brain is activated. This happens even when we are not moving. You can also mentally rehearse all of the worries connected to your pain. You can let them follow their logical progression and work out all of the scenarios. After reliving your fears many times you can poke holes in your reasoning and can also be at peace with every eventuality. The image below is a quote from The Brain's Way of Healing, it has a brilliant story of how effective imagery training can be for pain management.

9) Pain is context dependent. We feel less pain when we are safe, happy and relaxed.

List your favourite

• song

• smell

• food

• person

• words

When you next feel a pain twinge think of one of those distractions and keep adding until the safety messaging is greater than the pain messaging

10) What sentence do you need to hear every day for the next two weeks?

Write this out and put it on your bathroom mirror.

11) If you can reach your painful spot - massage it daily. Update the information that your brain has about your painful area. Stop it from taking mental shortcuts and further reinforcing your body's pain habit.

12) Control looks like:

• Setting boundaries with your time.                              

• Taking a class

• Making good food for yourself

• Creating a morning or evening routine

• Making time to enjoy a hobby

• Going to sleep on time.

When we feel that we have control over our life despite the pain then we are on the right path.

These are a few ideas to help you change your pain neuromatrix. Remember you have taken years to establish the pathways that these pain messages travel along. It will take you a long time to create new pain free routes. Placebos are one way to help you on your way.

And. If you have a weird rash or a new pain, get a doctor to look at that.

Xx

P