By Laura Rathbone
Reading:
Rossettini, G., Camerone, E.M., Carlino, E., Benedetti, F. and Testa, M., 2020. Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy. Archives of physiotherapy, 10(1), pp.1-12.
This month on Pain Geeks we have been spending some time exploring placebo and placebo effects and it brought back memories of being about 10 or 11 year old and 'feeling drunk' off of a cider lollie!
Do you remember those?
My memory is of being a very young kid with my friends roaming around the streets of my seaside Lancashire home town, passing endless terraced housing making a riot and falling over the place because we were daring each other to have more and more cider lollies...of course there was no alcohol in them at all, but we were young and didn't know that!
This particularly summer I remember as being one of the first summers I was aloud off 'the street' alone as we prepared to move up into secondary school and become real grown ups. So it made sense to us that now, we were aloud to buy the cider lollies (there were also shandy lollies which is usually lager and lemonade mixed together) that we hadn't dared to buy the summer before in case we were told off - clearly they were only for very grown up people.
The thing is, i remember feeling really drunk. I was more clumsy, my words were more slurred. Everything was just funnier...how though?
I had never been drunk before so I had no personal data of this feeling, but I had tried 'gas and air' when I had a dentist appointment, which all the grown ups told me felt like 'being drunk'. And, I had of course seen lots of people drunk - tourist seaside town in the UK are notorious spots of hedonism! And I'd seen my parents and older siblings drunk ... so I had some idea of what people 'said' it was like.
How did it happen?
Well, it could all be down to suggestion, context, observed responses and motivation having a powerful effect on how my body showed up for me, or, placebo effect.
Through studying placebo effect and placebo response researchers are helping us understand more and more how context dynamically interacts with our biology to create a desirable lived experience of a drug or therapeutic interaction - just like my cider-lollie experience.
This is what we loved about Rosettini's paper this month, the exploration not only of what are the placebo/nocebo effects present during therapeutic interactions, but why and how they might working - and that they are not specific to the therapeutic environment but happening all the time and that we are already skilled manipulators of them.
This paper provides a really comprehensive overview and exploration of contextual factors particularly relevant to the therapeutic environment, some of them easily modifiable in the case of verbal communication, appearance, marketing and posology (dosage) and some of them less so; patient mindset and previous experience.
Physiotherapy features: Professionalism, mindset, appearance
Patient features: mindset, baseline
Patient/physio relationship: verbal and non-verbal communication
Treatment features: Therapeutic touch, modality, posology, marketing
Healthcare setting features: Positive distractors, supportive indications, comfort elements, decorations and ornaments
I notice that there is a tendacy towards dualism and reductionism within the placebo literature that we as clinicians need to be wary of because, much like there is no single neurobiological mechanism bringing about the experience of pain, there is also no single biological mechanism for 'the placebo effect' and, as Rossettini et al points out, there are multiple placebo effects or complex processes bringing about different types of placebo effects.
We really enjoyed and were challenged by this reading and hope that you were too!
We are really looking forward to talking with Giacomo Rossettini on 30th August and if you are reader within the paid-for community then you are invited to join this discussion or catch the recording afterwards.