Non-pharmacological & Placebo treatments Flashcards
What does the placebo effect mean?
A medicine that is ineffective but may help to relieve a condition because the patient has faith in its powers.
When some people experience a benefit after the administration of an inactive “look-alike” substance or treatment
What is the nocebo effect?
Where a drug or procedure produces adverse effects that are not the result of any known pharmacological mechanism.
- e.g. drowsiness, nausea, fatigue, insomnia.
What are 3 types of placebos?
- Pure placebo - thought to contain no active ingredient e.g. a sugar pill.
- Impure placebo - contains an active ingredient, but one that is not known to have any effect on the condition being treated e.g. a vitamin C tablet being given for headache.
- Placebo procedure - a procedure e.g. taking blood pressure, which is not known to produce any clinical change.
What are the factors that contribute to a placebo response?
The physical appearance of the placebo- e.g. green tranquillizers reduce anxiety more than yellow or red ones.
Branding*- products that have been branded will produce greater effects than generic products or placebos.
The reputation of the setting - e.g. a university research unit will enhance treatment more compared with a back-street clinic.
The patient’s perception of staff attitudes affects response - e.g. where doctors are judged as more interested and enthusiastic, the results are more positive.
NOTE: effects are influenced bu culture, expectations, beliefs
Effects of placebos in pain management?
Shown to cause clinical improvement in many areas of medicine.
Can produce same phenomena seen in other drugs w/ active
- Habituation - a tendency to increase the dose over time.
- Withdrawal symptoms
- Dependence - an inability to stop taking them without psychiatric help.
- Inverse relationship btw severity of symptom & efficacy of placebo.
Debate about whether it breaks a patient’s trust to give them a placebo or whether we should be using the most effective drug, however it works.
How do placebos work?
- Social influence – doctors are perceived as people w/ authority so their direction & expectations are followed.
- Role expectation – the doctor’s role is to organise treatment, & the patient’s role is to get better, so the patient plays that role.
- Classical conditioning – for a patient, past experiences of taking drugs led to improvement, so the administration of a new drug is more likely to produce the same response.
- Operant conditioning – doctor rewards patient who shows sign of improvement, increasing the probability that the patient will continue to report improvement.
- Cognitive influence –patient has firm beliefs about medical treatment: e.g. ‘modern medicine is based on scientific evidence, therefore this drug will be effective’.
What are the different types of non-pharmacological pain managements?
Either physical interventions or psychological interventions!
Physical:
- Local heat, ice packs, wax baths & other external applications - induce muscle relaxation.
- Hydrotherapy (in a swimming pool) - it is warm, induces muscle relaxation & allows movement without the restraints of gravity or normal load bearing.
- Massage - muscle relaxation & stress hormone reduction.
- Exercise- weight loss can improve joint pain & exercise releases endorphins.
- Acupuncture - fine needles stimulate sensory neurones which results in the release of endorphins.
- Aids & appliances - e.g. raised toilet seats - provide dignity & independence. Occupational Therapists help here.
Psychological:
- Cognitive behavioural therapy - people react to & manage their illnesses in ways in which is consistent w/ their beliefs about their illness, themselves & their world (often unhelpful). Assess beliefs, impact, cause cure, prospects
- Mindfulness based stress reduction - pain & suffering are a part of life & we can learn how to deal w/ them & go on living (medical culture is that pain & suffering can be fixed)
- Acceptance and commitment therapy- Acceptance & mindfullness skills → greater psychological flexibility. Proposes that suffering is normal
What are the barriers to psychological treatment?
- Patients sometimes struggle w/ idea that real pain has a psychological cause rather than a pathological cause.
- Stigma & internalised stigma - afraid of what people will think.
If you are sending me to see a psychologist, do you think I’m mad?
What is the role for non-pharmacological pain management?
Pharmacological & surgical interventions are limited especially in chronic pain.
But can be effective if pain is caused by stress, cognitions (thoughts), emotions &/or behaviours.
Psychological interventions are about changing the individual’s relationship to pain.
- Distinguishing what can & can’t change = generating hope.
- Breaking down goals into manageable steps.
- Problem-solving around obstacles to making those changes.
- Identifying thoughts & thinking patterns which are unhelpful & learning to stop them.
