When the mere idea of a cure is enough

A patient is given a pill to take daily as a painkiller. After a
month, the pain is gone.

Surprise ““ the pill contained no active ingredients, but
was merely a sugar pill. The elimination of pain was a result of
what is known as the placebo effect.

The placebo effect is the physiological changes that can result
from simply believing one is receiving medication.

“The benefits of placebo are most prominent for illnesses
where the major symptoms are highly subjective ““ such as
pain, anxiety or depression ““ and the benefits of placebo are
usually short-lived,” said Andrew Leuchter, professor and
vice chair of the psychiatry and biobehavioral sciences
department.

In a UCLA study, patients with irritable bowl syndrome who have
recurrent abdominal pain without an observable cause of pain in
their gut, were given placebos for three weeks.

“What we’ve been studying is a mechanism by which
your thoughts can inhibit other things in your brain, like your
emotional and pain reactions,” said Matthew Lieberman, one of
the researchers involved in the experiment and an assistant
psychology professor.

The researchers then scanned the brains of the IBS patients with
functional brain imaging while their pain symptoms were
stimulated.

Researchers found less activity in the region of the brain
associated with pain. While the right prefrontal cortex, the region
of the brain associated with self-regulation of emotional
responses, was more active.

The study, led by Emeran Mayer and Bruce Naliboff, co-directors
of the Center for Neurovisceral Sciences and Women’s Health,
indicated IBS patients were feeling less pain because of the
placebo they were taking.

“There is pretty good data that certain physiological
processes actually do change with expectation or placebo
effect,” Naliboff said.

“Some of the processes underlying pain do seem to
change.” he said.

When a doctor prescribes medication to a patient the doctor is
also prescribing a belief that the drug will treat the patient,
Lieberman said.

“If you give someone a drug and don’t tell them
it’s going to help them it’ll help them some, but it
won’t help them as much as if you give someone a drug and
tell them it will help them,” he said.

Researchers hope to determine the degree to which a placebo can
be beneficial, and how much of a patient’s recovery can be
attributed to its effect.

“It may be more about the process that you engage in, not
simply that you think positively or you think negatively,”
said Anne Coscarelli, psychologist and director of the Ted Mann
Family Resource Center at UCLA’s Jonsson Comprehensive Cancer
Center.

“It’s whether you take positive steps to cope with
the problems that get presented to you,” she said.

In a UCLA depression study, Leuchter and his team of researchers
studied the effects of a placebo in comparison to an
anti-depressant medication. The patients on the placebo were used
as the control group for the study.

But the control didn’t remain a control group. Patients on
the placebo as well as the patients on the medication showed
changes in the prefrontal cortex region of the brain.

“We interpreted this to mean that there were different
pathways to improvement in symptoms of depression and that the
actions of medication are just one pathway,” Leuchter
said.

Yet Leuchter cautions using placebos as the sole means of
medication.

“The concept that placebo regularly “˜cures’
illness is false and no one should stop taking a proven medical
treatment in favor of placebo,” he said.

The opposite of placebos, nocebos, create symptoms like
headaches and nausea rather than alleviate them. Some research
subjects who were placed on placebos believed they would experience
the side-effects of the medication, and therefore developed them
afterward.