March 15, 2017

The Practitioner Placebo Effect

I am a generalist; there, I admit it. In a world of increasing specialization one gets the distinct feeling that “generalist” has become a rather dirty word. Almost 30 years ago, when I was studying osteopathic and naturopathic medicine, specialization within these fields did not exist or were in the very beginning stages. Of course, today that’s not the case.

Although my emphasis is in naturopathic and osteopathic medicine, my practice is very general, which is the way I like it. Every day is different. I may be working with someone suffering acute back pain in one appointment, while exploring management options for a migraine sufferer in another, and then later in the day having a deep conversation with a patient suffering from anxiety and depression. Jumping from orthopedics to neurology and then to psychology is the privilege that only comes from being a generalist. Naturally, knowing one’s own limitations comes with the territory, but that’s all part of being a good generalist.

Over the years I have also come to understand and respect the need to see a patient’s problem from many different angles. In some cases, there is no cure and all we can offer is an effective management plan.

Let’s use the typical presentation of an osteoarthritic knee as an example. In essence, once this process has gone beyond a certain point, there is little that can be done other than surgery. However, I have a devoted following of such knee pain sufferers —which I refer to as my knee club—that have defied the surgeon’s desire to slice-and-replace in favor of a regular visit to the clinic for a chat, an examination and some acupuncture. These patients are actively participating in life with minimal limitations, but they should have had their new knees fitted years ago.

With my knee club members and other patients, I believe their successful and effective therapeutic experience comes from nothing more than the ancient art of “I shall please.” This is an art form I have embraced long ago as a happy generalist. As a result, I think I have become a very effective placebo!

Maybe the conventional medical and scientific communities have been right all along, but have failed to appreciate just how powerful the placebo response actually is. A placebo exerts an incredibly strong bodily reaction when used ethically and correctly, and should not be viewed as a sham treatment. If by simply interacting with a patient, empathizing and believing their pain to be real, taking the time to examine and offer some treatment to the region in question, is considered to be a sham approach, then add this to my list of therapies offered. Because it works!

Hard science has proven how specific brain centers light up during such a doctor/therapist-patient interaction. For example, simply by showing compassion for a patient’s physical pain, the anterosuperior-posteromedial cortex jumps into life. Add some empathy for their life and social situation and the anterior cingulate gyrus and three other areas start chattering.1 Include some personal beliefs and positive experiences, such as how acupuncture has helped in the past, and you start to get a very powerful collection of higher center effects that will exert significant overriding control on the complex pain mechanisms.

My “knee club” is testament to the power of such a therapeutic encounter. What is even more impressive is the fact that an acute flare of osteoarthritis pain can be effectively and significantly reduced by a quick visit to the clinic for this “therapy-cocktail” of acupuncture and empathy.2-4

I for one, will carry on helping my patients in my generalist way but will continue to respect the placebo response for what it really is: a safe, effective and side-effect free method of channelling the body’s innate healing mechanism Wait! Isn’t that the key principle of naturopathy?

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