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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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • tucker
    7 years ago

    I would love to believe in that placebo effect (if not for the costs alone!!)because I sure have spent my share on complementary medicine and recommended supplements. I’ve tried acupuncture, 3 different chiropractors, about 10 years of massage therapy and even a session of hypnosis. I’ve stuck out years of the complementary magnesium, coenz Q10, and Vit B2 with a break for about 6 months not seeing a difference the second time. I even tried 3 months of physical therapy for chronic neck pain related to migraines. All of these are totally cash out of pocket with the exception that I had a healthy copay on the chiropractor and PT. Honestly, I never felt that any of these got me anywhere. The massage feels great at the time and I had a great relationship with one of my favorite folks (so I guess you can even add in a little talk therapy for the price) but she kept recommending chiropractors and acupuncture and I’ve given her a break b/c gotten tired of hearing that advice when I tell her been there, done it, not going back.

    At this point, I’d love someone to tell me this lovely rainbow colored pill will fix your broken body. You will sleep thru the night, you will not ache when you wake up refreshed. Your kidneys and heart will function properly and you will breath better. Your head will never hurt again and your stomach will not churn at the smell of bad breath, BO, and day old garbage or most foods cooking, esp those veggies and fish that are good for you. OF course, I’m sure 1-800- bad drugs would find something wrong with any rainbow colored drug but hey, with those promises, I would try it anyways! Until then, I’ll stick to my thermacare and heating pad and antinausea meds since a clothespin pinches too much. And hope my husband keeps his boring old job with really good insurance that covers the rest of my traditional meds.

  • Dawn A Marcus
    7 years ago

    Studies pretty consistently show that about one in three people will get migraine improvement with a placebo. If it’s JUST a sugar pill and nothing else, this effect is generally temporary and will wear off. The main point about “placebo effect” is to recognize that our ideas about treatment have an important impact on whether we will try a treatment, stick with it, and get benefit from it. The placebo effect probably won’t make a totally useless treatment seem helpful, but the placebo effect definitely can help make useful treatments work better. Just because the placebo effect boosts treatment benefits doesn’t make the treatment any less real or useful.

  • Maggie McNeely
    7 years ago

    Good points, Doctor. Placebo affect tends to sounds like blame or disregard for a real problem. It makes more sense to take advantage of the fact that our thoughts and approach to treatment can have some effect on the outcome.

  • Susan Jillian Smith
    7 years ago

    Sorry, I’m not buying this. I have always known when I was given meds that were fake. I suspect there is another side to this we are not seeing documented. I am highly suspect of these articles as they tend to neglect stating how severe and frequent the pain was. Also they leave out info about the people who did not improve or respond.

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