Harnessing placebos in daily practice

 

The ACT Forum, be held on 22 November, will explore the topic: honest use of placebo in physiotherapy practice—bringing the science to the bedside. Associate Professor Damien Finniss will provide an overview of the conceptual issues in the field and the science of placebo effects. Particular focus will be placed on the practical and honest application of this work to daily clinical practice.

Damien says ‘the idea of a placebo is traditionally about doing nothing, or giving something that’s ineffective, but what we have to realise is that if we give someone a placebo the reason they get better is not because of the placebo we’ve given, but the way that the therapeutic ritual or psychosocial context around the patient effects their brain.’

Exploring the science behind the mechanism of the mind–brain interaction, attendees will gain a contemporary view of what placebo effects are, and the new conceptual understanding of why people respond well when given a placebo. ‘A large part of the talk will look at how to extrapolate that to a real-world clinical practice in a honest and transparent way and present new research on how we might be able to harness placebo effects at the bedside, whether that’s in primary care or in the hospital setting,’ Damien says.

‘Part of the reason patients improve with a given treatment is due to endogenous placebo mechanisms, even if a traditional placebo is not given. This is an important new conceptualisation of placebo, demonstrating that placebo effects are a part of our daily practice.

‘I think if we can break down some traditional myths about placebo, and realise that we can use placebo mechanisms in an honest way without deceiving patients, perhaps we can improve clinical outcomes across a wide range of clinical practice.’

Placebo effects can have a very mixed meaning for physiotherapy practice, particularly given the inherent need for a biomedical focus. ‘Despite the importance of our targeted treatments, there is a component that could be equally, if not more important in some patients. This component is the placebo component of treatment,’ he says. Damien believes that if participants can understand this, it will be relatively unique and has the potential to be a powerful addition to their practice.

Placebo has been a part of clinical practice for hundreds of years. It is now appreciated that placebo effects can operate in daily healthcare practice, even when a traditional placebo is not given. These mechanisms can potentially augment outcomes, both in the short and long-term. ‘The science of placebos is really at the cutting edge in both management of pain but also of the therapist–patient interaction,’ Damien says. ‘We now know that it can play a significant role in clinical outcomes.’

 

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