If people believe that therapy cures their disease and their condition actually improves, even though the treatment has no effect from a medical point of view, for example because tablets do not contain any medicines, we speak of a placebo effect.
This placebo effect has been demonstrated in various studies. Today we know that the organism supplies the patient with neurotransmitters and hormones in such situations - the belief in the effect of an ineffective treatment triggers the self-healing of the body.
Conversely, there is also the nocebo effect: If you are convinced that a treatment, a medication or an operation has bad effects, the pain increases, the healing is delayed or the symptoms even worsen.
Explanation for the placebo effect?
Today neuromedicine can explain how the placebo effect relieves pain: We do not immediately feel pain in an injured area, but the peripheral nervous system and the spinal cord send the information "pain" to the brain. The brain has a pain memory. That means: Depending on how we are conditioned, the brain classifies pain more or less or not at all.
The body's own drugs release hormones and neurotransmitters in the brain that regulate the “pain” signal. The body's opioids are linked to the same switching points as artificial pain relievers. The happiness hormone dopamine can be triggered by the placebo effect, while cholecystokinin triggers fear and is released by the nocebo effect.
Usually the pain develops on the wound and the information travels to the brain in a very short time, which responds to the pain. In contrast, in the placebo, the prefrontal cortex expects pain relief. Therefore, it sends signals to the areas of the brain where the opioids form and run through the spinal cord to the wound. Those affected do not suppress the pain, but actually alleviate it.
Sham operations and pill size
Even sham operations work for some patients. In pseudo-drugs, many small pills work better than one large one. And the same rule applies as for branded products: the more expensive the ineffective pills are, the more effective people think they are.
Placebos also have a negative effect. For example, patients choked out their stomach contents after ingesting an alleged emetic.
The emotional brain
Neurologist David Servan-Schreiber suspects that more than half of all doctor visits are caused by stress. And the majority of all medications in western countries are used to relieve stress-related ailments: antidepressants, tranquilizers, antacids for heartburn, anti-hypertensive agents and high cholesterol. Alcohol is also a means of dealing with stress and depression.
The limbic brain regulates the emotions, and with it the almond kernel, from which fear reactions originated. This “emotional brain” controls heart function, blood pressure, hormones, the digestive and immune systems, breathing, appetite, sleep and libido. The “killer cells” of the immune system are controlled by the emotional brain. So while positive emotions like calm or well-being activated them, fear, stress and depression would inhibit them. This emotional brain has the ability to heal the body itself, and it can be "programmed" to do so, Servan-Schreiber said. Well-known methods can also be used for programming: the stings of acupuncture needles would deactivate the pain centers.
The neuroscientist Benedetti says: "The interaction with the doctor, the environment of the doctor's office or the clinic with its typical smells and noises - all of these are powerful sensory stimuli that the patient associates with a therapeutic action."
Two phases of pain
The placebo effect runs in two phases, firstly expectation and secondly learned reaction. First the network comes into action, which prevents the pain stimulus from reaching the brain, secondly it slows down the activity of pain-processing brain regions. There is not a placebo effect, but various, according to Benedetti. And it depends on the previous conditioning which biochemical mechanisms take place.
For example, a placebo pain reliever releases various neurotransmitters, depending on which analgesic patients had previously received - if people were used to morphine, the body emitted opioids. In Parkinson's patients, free dopamine in the body increases up to 200% when using placebos.
Placebo effect increases the effect of real medication
Benedetti also examined how the stimuli of medical treatment influence the effects of medication. Patients with postoperative pain received their analgesics either openly from a doctor or concealed via a computer-controlled injection pump. The result was clear: the concealed injection was less effective for all painkillers tested. With open injection, the expectation already releases messenger substances, and they occupy the same receptors as the analgesics, according to Benedetti. That was also the case in time: with the medical infection, the pain was relieved immediately, with the concealed one it took much longer. According to the researcher, Benedetti's experiments can be used to test when drugs are pharmacological and when they have psychological effects.
Doctors and the placebo effect
Scientists at the Institute for Medical Psychology at the Ludwig Maximilians University (LMU) in Munich are targeting the placebo effect. The doctor Karin Meissner, who works there, is aware, for example, as a scientist that acupuncture is of little use objectively, but she nevertheless successfully uses it against complaints such as hay fever.
Studies at the LMU institute showed that it doesn't matter whether doctors place the needles according to the "energy meridians" of traditional Chinese medicine or distribute them without a pattern on the skin. The result stunned: the needles worked in both cases. Meissner explains this with the placebo effect. So the expectation of the patient and the circumstances act like the trust and the calming words of the doctor.
The American medical professor Ted Kaptchuk gave patients placebo pills for irritable bowel syndrome in 2010 and even informed them beforehand that they were placebo. Nevertheless, the symptoms of patients treated with placebos improved significantly compared to subjects who received no treatment. Doctors, psychologists and neurobiologists therefore rely on involving and educating patients. Neurologist Ulrike Bingel says: "The patient must understand the meaning of therapy."
So instead of giving placebos to patients without them knowing about it, doctors should explain to those affected that they are placebos, how the brain produces messenger substances and hormones, and why the positive attitude of the patient affects the result. The American doctor Jo Marchant considers such self-healing to be more successful the more a person imagines his healing. For example, he could literally imagine how a wound closes, how knee pain ends or how he can walk again. Incidentally, shamans teach such precise healing images worldwide.
Second, trust in the attending doctor is crucial. Therefore patients should rely on their “gut feeling”. If friends trust a doctor, this is transferred to those affected because the brain does not differentiate between their own experiences and information from other people. If friends also support the patient, this promotes the placebo effect. The brain then releases oxytocin.
With placebo pills, but also with drugs that actually work chemically, the effect increases through rituals. This can mean taking your “medicine” at the same time at the same place, using a certain glass for rinsing, or even designing a “solemn” act.
A common example of the placebo effect is homeopathy. Here substances are diluted to such an extent that they are chemically no longer available. Critics of homeopathy attribute the successes in curing diseases to the placebo effect. An accusation that practicing homeopaths vigorously contradict, although a therapeutic application of the placebo effect can also make sense.
Homeopaths take their time and deal with their patients' individual complaints. So it is a special setting plus therapist-patient relationship. The doctor and patient also believe in the power of homeopathy. Critically formulated, the procedure consists of an unstructured talk therapy plus placebos. The question is whether the sugar globes not only function as a symbolic medium that only makes communication between doctor and patient, such as the release of hormones and neurotransmitters, flow.
An old story
Hippocrates used placebos in ancient times, methods that he knew were ineffective. And shamans stage a magical theater in which they conjure up foreign bodies that are said to cause the disease in the patient's body and which they remove with “mental operations”.
Some abuse the beliefs of their fellow human beings to charlatanize. Usually, the healers of traditional cultures do not behave differently from today's doctors, who know how the white coat, a gentle voice and associations with the hospital are part of a cure.
Military physician Henry Beecher put the placebos on a scientific footing in World War II after watching a nurse inject saline instead of morphine and the patients were still doing better.
Beecher also inspired the double-blind studies that we use today to determine the effectiveness of medicines. The test participants do not know whether they are getting real medication or pseudomedicine.
Placebos for phobias
Placebos work extremely well against phobias, because they form in the brain and can be changed by positive suggestions. For example, 34 women with an excessive fear of spiders underwent a study in which they allegedly received Angostura, a medicine from South America. In reality, they were consuming pure silica. All subjects felt much less disgust with spiders after the placebo than without the dummy. Researchers are now planning to use placebos as a first step in psychotherapy for phobias, especially to show patients how effective their self-healing is at overcoming the symptoms.
Religious ritual and placebo
Hindus cleanse themselves ritually in the Ganges, which in “holy cities” like Vahranassi, the city of the god Shiva, is chemically a sewer, and whose water should lead to various infectious diseases rather than cure them.
The hope that prayer helps leads to the release of hormones and messengers as well as the belief in the effectiveness of a placebo pill. A study at Georgetown University showed that belief in supernatural help accelerated healing in 75% of patients.
This positive self-suggestion applies to many areas of life. If I believe that the woman of my heart loves me too, that alone creates positive emotions, even if it is not true. This also applies if I believe that a kind God loves me and hugs me after my death.
This anti-realism in religions could be described as a placebo for everyday life: whether someone prays to the rain god that the harvest does not wither, or thinks that God is at his side when he undergoes a heart operation. These are all self-suggestions that can lead to the body producing the appropriate opioids and hormones.
Religion cannot be reduced to the alleviated alleviation of pain, but it does play a significant role. It is no coincidence that Christians ask the Lord's Prayer “and deliver us from evil”, and the goal of Buddhism is to overcome suffering in life. A crucial lesson in Buddhism is to accept pain without raising the alarm. This could be described as reducing pain awareness, which in turn is a classic placebo.
Suffering is the core of Christianity. The crucified Savior took on the sins of mankind and their pain, and Apostle Paul taught: “We suffer, but not like others who have no hope.” Faith itself, and no supernatural power, relieves the pain. It can also be understood that people find faith in bad phases of stress, be it that a 14-year-old begins to believe in God while her mother is in the clinic with cancer, or a drug addict in religion is his last chance sees.
Such placebo effects are obviously greater the more fundamentalist a person practices his religion. Moderate Christians who accept scientific theories therefore produce less of the body's pain suppressants than fanatics who insist that miracles happen. Conversely, this spiritual enthusiasm also leads to deep despair when an expected miracle does not come true.
Is there also a rational alternative to religion to use the power of the placebo over physical and emotional pain? That should be difficult, because self-suggestion works better, the less those affected know that it is a suggestion. (Dr. Utz Anhalt)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. phil. Utz Anhalt, Barbara Schindewolf-Lensch
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