“The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.” – Science Daily Sugar pills relieve pain for chronic pain patients: Placebo benefits can be predicted by brain anatomy and psychological traits
So, I am officially none of the traits listed for placebo beneficence. I cannot tell what I am feeling until it’s turned up to eleven, I am remarkably insensitive to painful situations (electric stimulation being a notable exception), and I am physiologically incapable of being mindful of my environment. Basically, if you have autism, sorry, you get nothing from placebos. Next patient, please.
If only I could just leave it at that. But no, the article disturbed me, dragged me away from an immense load of schoolwork, and now here I am trying to wrap my head around it.
I have a very strong negative reaction to the assertion that placebos work on chronic pain, since I can count on one hand the number of people I have encountered for whom this is true, all two of which reported an improvement in their condition as a result of acupuncture. It’s no secret on this blog that I consider acupuncture to be the most nefarious example of woo crap that has gone mainstream (although certainly not the most nefarious example of all woo crap, a title for which homeopathy and energy healing are locked in a dead heat). The science is clear. Acupuncture is a placebo. Period. If it’s worked for you, great, you’re one of the lucky ones, throw away all your anti-inflammatories, Skittles and m&ms will do the job for you from now on.
This study’s findings make the arguments against woo much more challenging, because researchers have now discovered a discrete subset of people for whom placebos will work and they can even define the specific psychological traits associated therein. Which means that most placebo-susceptibles will go through their lives thinking that homeopathic sugar water fixed their indigestion and energy healing worked on their lower back pain, and they will swear to this fact up and down to anyone in internet distance and in the face of whatever science gets thrown at them. They’re never going away. And because of this subset of patients, woo is never going away, either.
I suppose on some level I had always assumed that woo would have its fifteen minutes, like, you know, patterned leggings or buttered coffee or whatever, and then slip back into the obscurity from whence it came. An obscurity that, up until about five minutes ago, I wholeheartedly felt it richly deserved.
But who am I to take away the thing that takes away someone’s pain?
If a placebo had worked for me (hasn’t happened), I’d have been overjoyed, ecstatic, f*** the science, I would have shouted it from the rooftops. My pain was cruel, severe, and encompassing, it shut the rest of my life away, it took over nearly all of my waking moments and too many of my sleeping ones. And from that perspective, by all means, if a placebo-like-something works for you, don’t question it, because real pain medications come packaged with hormonal, neurological, psychosomatic, and gastro-intestinal side effects.
Chronic pain sufferers, as a general rule (exceptions exist), have a love-hate relationship with these substances and have to strike a balance between the quality of life subtracted by the pain versus the quality of life subtracted by the side effects. I take a handful of pills three times a day, a considerable chunk of which is devoted to side effect amelioration. My pain is kept pretty low, so low that I’ve tried to disengage from the pain meds a number of times, only to be beaten back into submission three or four days later by a pain spike that takes a few weeks to get back ahead of. If I could take a handful of chocolate chips instead…honey, you better believe I’d be on that like fudge on a sundae.
I’ve spent years – literally – drawing a canyon in the sand between woo and science-based medicine, firmly planted on the take-your-woo-and-shove-it side of it. The whole industry infuriated me; it was all fake, and I felt that the snake oil salesmen perpetrating their supposed chakra misalignments knew it was fiction and took people in anyway, ethics be damned.
Now I have to concede that at least some of these people may honestly believe what they do works because they’ve undergone the treatments themselves and the treatments worked for them. Now I understand the vehemence of the arguments I’ve gotten into with people about acupuncture. They are as certain that it works as I am that it doesn’t and we’re both right.
What a mess. My scientific brain is tied up in knots.
Now, this is just one study. Replication (or lack thereof) would go a long way towards helping me sort this out. I don’t want people to be taken in; it makes me seethe to see desperate people throw money at charlatans.
But even more so, I don’t want people to be in pain. Physical pain takes over your sense of self, and may actually permanently rewire your body’s pain signaling network, and not to good end. Pain sinks into every crack and crevice of your life. Everything else seems little, expendable, pointless in comparison. If I could spare a single human being that experience by sending them to a naturopath, would I do it? If I knew that it would work?
What would be the right thing to do?
I was so sure, before. Now, all of a sudden, I don’t know.