Psychological techniques offer more than placebo for migraine sufferers

As a chronic pain doctor, I've spent a career working in a multidisciplinary practice, working side-by-side with nurses giving dietary and sleep instructions, physical therapists providing exercise strategies, and psychologists training patients with biofeedback, stress management, and coping skills.

We've performed research studies evaluating the impact of non-drug treatments and spent hours reading the research of others. These studies consistently reach the same conclusion: non-drug therapies are real, effective treatments that, in many cases, work at least as well as standard medication therapies. Research has proven that non-drug therapies cause real changes in the brain and body that are similar to those achieved by taking medications. Non-drug treatments don't just make patients THINK they're going to get better, they genuinely help people reduce disabling symptoms. As a doctor I know that patients will get the best pain relief when they use effective drug and non-drug therapies.

So imagine my surprise when I was pouring over recent medical journals today and read the title of an article in the Journal of Headache and Pain that read, "Placebo and other psychological interactions in headache treatment." The authors explored why placebos can be effective and talk about "non-specific psychological effects" as important factors. They further argue that improvement from many non-drug procedures, including biofeedback, acupuncture, and behavioral therapies are at least in part due to "placebo and non-specific psychological effect." I would argue that these authors have missed an important opportunity to harness the placebo effect and recognize that placebo effects play an important role in both drug and non-drug therapy. And that both drug and non-drug therapies, despite potential enhancement through placebo effects, can offer real, effective treatment for patients.

The placebo effect is really your brain's tendency to make changes in expectations of an effective therapy. If you think a treatment is going to work well, your brain can help set the stage to make your body's physiology more receptive to treatment benefits. If, however, you believe a treatment will be worthless, your body can set up barriers that can prevent your body from responding to even the best treatment. The real question for doctors and patients is not "is some of the benefit caused by a placebo effect?" but "how can we take advantage of the placebo effect that can occur with both drug and non-drug treatments to help boost our patients' response to therapy?" Placebo effect is not something unique to non-drug therapies or only pain conditions. Placebo effect occurs with every treatment we use for every health problem. How we think about our health, our healthcare providers, and our treatment can significantly impact how well we respond to prescribed therapy. And that's true whether our therapy is a pill or psychological therapies.

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