Recently Lorimer Moseley spoke with Dr Karen Litzy on her podcast Healthy Wealthy & Smart. His final remarks on placebo caught my attention. They’re not new thoughts, and have definitely been expressed elsewhere, but as always, Lorimer is succinct and engaging. Here’s a small part of the end of the chat, but indulge yourself and listen to the whole thing.
“I don’t think there is such a thing as a placebo effect – the notion is nonsensical, that something that is inert can have an effect.
We clump a whole lot of effects under the banner of placebo and as we learn more about what those contributions are, the apparent size of the placebo effect gets smaller because it doesn’t now include things like expectation, conditioning, rapport, therapeutic alliance. Perhaps once day there will be nothing left to attribute to that sort of nebulous, mysterious thing.
I think that there are very few, if any, PT treatments where there is a lot of research to say it has no effect. What I think the research does say is that the effect that it seems to have is not mediated by the mechanisms we thought it was mediated by.
A classic example of that might be types of manual therapy – initially we presumed it’s because the joint is having biomechanical activities that return movement to normal. Then we learnt, well hang on, maybe it’s about the receptors in the joints that are having an effect at the dorsal horn – but hang on, it doesn’t matter if you do it to the next joint. So maybe it’s an endorphin related effect. Then we might learn, maybe it’s a few of those things put together, but maybe its powerful safety cues in the context of movement. So … the RCTs, if they’re designed well, will probably reveal that it’s not what we thought it was that’s having the effect.” (Lorimer Moseley 2017)
Lorimer explores how we can challenge our theories and hypothesis, and why we should, to a larger extent in Explain Pain Supercharged. With his usual dignified eloquence, he begins this exploration by equating theories with farts. Here’s a sneak peak …
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