Myths and Truths about Placebo Effect in Rehabilitation for Musculoskeletal Pain, 2021, Iolascon and Moretti

Abstract

This commentary provides the authors’ point of view about the biopsychosocial perspective of placebo effect on musculoskeletal pain in the rehabilitation field.

Key Summary Points

Rehabilitation interventions, including physical therapies, play a leading role in the management of musculoskeletal pain, though their effects should still be clarified.
It is often argued that the effects of rehabilitation interventions are due to the “placebo effect”. This commentary provides the biopsychosocial perspective of placebo effect on musculoskeletal pain in rehabilitation.

In randomized controlled trials performed in a rehabilitation setting, for patients included in the placebo group (untreated or receiving sham physical therapy), there are beneficial physiological and psychological reactions due to the personality of the patient, the relationship between the therapist and the patient, the type of environment and location where rehabilitation is provided, the use of complicated devices or equipment, and the patient's expectations of improvement and/or recovery. The neurophysiological basis of a placebo effect in rehabilitation concerns psycho-neuro-endocrine-immunology.

Psychological mechanisms can induce a therapeutic effect in chronic pain conditions through the conscious anticipation of the benefit induced by the therapy, the conscious conditioning due to the sight of sophisticated instruments, and the unconditioned stimulus due to the administration of therapy.

Placebo analgesia results from different pain modulation mechanisms: the activation of descending circuits involving the dorsolateral prefrontal cortex, rostral anterior cingulate cortex, and periaqueductal gray; the modulation of pain processing by inhibiting the middle and posterior cingulate cortex, insula and thalamus; the inhibition of cholecystokinin (CCK); the activation of endocannabinoid system; and the modulation of prostaglandins synthesis.

Open access, https://link.springer.com/article/10.1007/s12325-021-01894-5

 

Uh uh. That close to being as condescending as "women can't resist a shiny diamond". Do they really believe that people are impressed by the "sophisticated instruments" at physical therapists? Seriously? People who routinely use a supercomputer connected to the rest of human civilization are supposed to be impressed by, what, a centrifuge? Weights & pullies? Is there any device that even qualifies as a "sophisticated instrument" in a typical clinical setting? Certainly none that I can remember.

The way medical professionals speak of patients is way too close to how imperial governors used to speak of "the natives", and judging living in a primitive society as being equivalent to being stupid, as if they are smart for being born in the right place and time.

 

Myths, Damned Myths and Statistics about Placebo Effect...?

 

haha i have giggling for about 20 minutes at that rvallee

"sophisticated instruments" Ooooo I'm so impressed!

 

Oh dear!

 

There is a popular belief amongst the privileged that being born out of the right vagina automatically makes them entitled to lots of money, makes them cleverer than people who came out of non-rich vaginas, and makes them more stylish too.