Posts Tagged ‘Luana Collaca’

Suggestible You 10

March 26, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.     This is the tenth post on this book.  This post describe the role of  placebos in addiction.

Approximately 1 in 10 Americans is addicted to some kind of drug—mostly alcohol, although opioid addiction is gaining quickly.  Traditionally addiction has been viewed as a moral failing or a lack of willpower.  Today we understand addiction is mostly physiological, specifically around dopamine.  This is not surprising since this neurotransmitter deals with the anticipation and enjoyment of rewards.  Vance note that this includes sugar, sex, money, a high score on Grand Theft, as well as drugs.

Unfortunately, drug use doesn’t just change the way you feel for a couple of hours: it can also change the brain itself.  When the nervous system is presented with an abundance of pleasurable chemical stimulation through drug use, the nervous system gets overwhelmed and shuts down its production of dopamine to bring itself back into equilibrium.  This creates a bad feedback loop in which the person finds himself short on dopamine whenever he’s not using the drug.   Food no longer tastes as good, and sex can lose its thrill.  Taking the drug that caused this problem is the only way to get back to something close to normal.

Addiction literally changes the way the brain works.  Not only do addicts have less dopamine from drug overuse, but also their  dopamine receptors are affected (either changing their numbers or changing how well they transmit messages).  Regular drug uses twists memories so both the drug and the circumstances surrounding the drug use.  Addiction causes the brain’s impulse control centers to shut down, which greatly increases the chances of relapse.  If cocaine addicts are shown an image of blow for as little as 33 milliseconds, which is too fast to register in consciousness, they will have immediate cravings.

Vance sees addiction as sort of a perversion of all the brain circuits and processes  in his book.  Consequently he thinks that suggestion and expectation may hold the answers to overcoming it.  Naloxone, the drug that first helped expose the chemical nature of placebos and blocks placebo responses altogether, wasn’t invented for placebo research.  It serves a crucial role in medicine as an emergency treatment for drug overdoses.  It’s also pretty effective at blocking the effects of heroin or oxycodone.
A closely related drug, naltrexone, is one of the most effective treatments for alcohol abuse.

People get tipsy when a nonalcoholic beer is substituted for an alcoholic beer.  This also works the other way.  A study at Minot State University doctored root beer to give it the same alcohol level as regular beer.The researchers offered the doctored drink to a group of unsuspecting volunteers, while another group received regular beer.  Not surprisingly, both groups got tipsy after a few drinks. What is interesting is that those who drank beer actually absorbed more alcohol into their blood than those who thought they were drinking soda but were in fact consuming just as much alcohol.

It is clear that work on treatment is still a work in progress, but progress is being made.

Some two million Americans are addicted to prescription opioid drugs and about 19,000 died from overdoses in 2014.  This is about twice the number who died from heroin overdoses, and three times the number who died from cocaine.  One theory of pain is that after an injury, the pain never leaves, it just gets gradually covered up by the body’s internal medicine.  A team led by Bradley Taylor gave naloxone to patients who had recovered from an injury and for many of them the pain came right back as if pain had been hiding under the surface for this whole time.  These patients displayed some of the hallmarks of opioid withdrawal.  During the process of recovering from pain, we actually become dependent on our own opioids.   Taylor thinks that this may be the key to understanding not only addiction, but also the switch from short-term to chronic pain.

Given this understanding, NIH researcher Luana Colloca, whom we have encountered previously, is studying the role placebos my play.  She mixed a few placebo pills into a group of pain patients’ medication.  Each week they have five or six pain pills and one or two placebos.  As the week progressed, she upped the placebos and topped the opioids until the artificial was administered only about half the time.  The results of the project are not reported, but the idea is clear.  The patient is trained to expect pain relief when taking a pill.  Gradually she takes the pill away and lets the patient’s own expectation cover the pain relief.  The patient uses her expectations to switch from an external drug to an internal one.

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.     This is the tenth post on this book.  This post describe the role of  placebos in addiction.

Approximately 1 in 10 Americans is addicted to some kind of drug—mostly alcohol, although opioid addiction is gaining quickly.  Traditionally addiction has been viewed as a moral failing or a lack of willpower.  Today we understand addiction is mostly physiological, specifically around dopamine.  This is not surprising since this neurotransmitter deals with the anticipation and enjoyment of rewards.  Vance note that this includes sugar, sex, money, a high score on Grand Theft, as well as drugs.

Unfortunately, drug use doesn’t just change the way you feel for a couple of hours: it can also change the brain itself.  When the nervous system is presented with an abundance of pleasurable chemical stimulation through drug use, the nervous system gets overwhelmed and shuts down its production of dopamine to bring itself back into equilibrium.  This creates a bad feedback loop in which the person finds himself short on dopamine whenever he’s not using the drug.   Food no longer tastes as good, and sex can lose its thrill.  Taking the drug that caused this problem is the only way to get back to something close to normal.

Addiction literally changes the way the brain works.  Not only do addicts have less dopamine from drug overuse, but also their  dopamine receptors are affected (either changing their numbers or changing how well they transmit messages).  Regular drug uses twists memories so both the drug and the circumstances surrounding the drug use.  Addiction causes the brain’s impulse control centers to shut down, which greatly increases the chances of relapse.  If cocaine addicts are shown an image of blow for as little as 33 milliseconds, which is too fast to register in consciousness, they will have immediate cravings.

Vance sees addiction as sort of a perversion of all the brain circuits and processes  in his book.  Consequently he thinks that suggestion and expectation may hold the answers to overcoming it.  Naloxone, the drug that first helped expose the chemical nature of placebos and blocks placebo responses altogether, wasn’t invented for placebo research.  It serves a crucial role in medicine as an emergency treatment for drug overdoses.  It’s also pretty effective at blocking the effects of heroin or oxycodone.
A closely related drug, naltrexone, is one of the most effective treatments for alcohol abuse.

People get tipsy when a nonalcoholic beer is substituted for an alcoholic beer.  This also works the other way.  A study at Minot State University doctored root beer to give it the same alcohol level as regular beer.The researchers offered the doctored drink to a group of unsuspecting volunteers, while another group received regular beer.  Not surprisingly, both groups got tipsy after a few drinks. What is interesting is that those who drank beer actually absorbed more alcohol into their blood than those who thought they were drinking soda but were in fact consuming just as much alcohol.

It is clear that work on treatment is still a work in progress, but progress is being made.

Some two million Americans are addicted to prescription opioid drugs and about 19,000 died from overdoses in 2014.  This is about twice the number who died from heroin overdoses, and three times the number who died from cocaine.  One theory of pain is that after an injury, the pain never leaves, it just gets gradually covered up by the body’s internal medicine.  A team led by Bradley Taylor gave naloxone to patients who had recovered from an injury and for many of them the pain came right back as if pain had been hiding under the surface for this whole time.  These patients displayed some of the hallmarks of opioid withdrawal.  During the process of recovering from pain, we actually become dependent on our own opioids.   Taylor thinks that this may be the key to understanding not only addiction, but also the switch from short-term to chronic pain.

Given this understanding, NIH researcher Luana Colloca, whom we have encountered previously, is studying the role placebos my play.  She mixed a few placebo pills into a group of pain patients’ medication.  Each week they have five or six pain pills and one or two placebos.  As the week progressed, she upped the placebos and topped the opioids until the artificial was administered only about half the time.  The results of the project are not reported, but the idea is clear.  The patient is trained to expect pain relief when taking a pill.  Gradually she takes the pill away and lets the patient’s own expectation cover the pain relief.  The patient uses her expectations to switch from an external drug to an internal one.

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Suggestible You 2

March 18, 2017

“Suggestible You” is the title of a book by Erik Vance.  The subtitle is “The Curious Science of Your Brain’s Ability to Deceive, Transform, and Heal.  This book is about the placebo response and related phenomena.   This is the second post on this book.

Vance participated in an experiment in Luana Colloca’s laboratory on the campus of the National Institutes of Health.  Dr. Colloca attached a variety of devices to Vance including two on his left hand.  One device delivered the shock, the other, on his middle finger.  She said that this device will tap into the A-B fibers in his hand that will occasionally interrupt the shocks, nearly cutting the pain altogether.  As he explained it, the difference between the weak shock and the powerful shock would be that one has a crossing guard and the other does not.  He was told that he would know which one was coming via a screen that will turn green when the A-B fibers are blocking the pain and red when they are not.

Vance said that the small shock feels like a pinprick or a pinch, but the bigger shock doesn’t feel like a bigger pinprick. He said that it’s more like a dull squeeze wrapped in fire, localized in his hand but seemingly all over his body as well.  Colloca slowly increased the strength of the shock, working Vance up a scale of 1 to 10 (10 being the worst tolerable pain), testing his pain threshold.  He agreed to a shock level of 6, although he said that this was very uncomfortable.  He went through two rounds of 12 shocks each.

On the third round he noticed that the green (weak) shock) had gotten slightly worse—maybe from a 1 to a 2.   He thinks there might be a problem with the shock blocker.  They ran through 11 more trials and the torture session was over.  When Colloca returned she told him his pain threshold was smack in the middle of the bell curve for pain, which is 100 hertz of electricity.  She remarked that pain thresholds vary tremendously among individuals.

Then Colloca pointed to a sheet of paper showing Vance’s third round and dropped a surprise telling him, “In Block 3 we used green and red both at 100 hertz.  You felt the green as less painful, compared to the red, when actually you received the same, and that is the placebo effect.”  There never was any magic pain-lessening wire.

The question regarding why the placebo effect works was addressed by a team in Scotland in 1975.  We do have a form of homemade opioids called endorphins.  These endorphins play a number of tiles in our brain, such as regulating circadian rhythms,  appetite and body temperature.  They are the primary chemicals that make sex feel so good.  Two neurologists, Jon Levine and Howard Fields conducted a simple experiment with people in pain after dental surgery.

The plan was to give a group of patients who had recently had a dental procedure either a placebo or naloxone.  Naloxone blocks the endorphins.  They told all of the patients that they were receiving a painkiller.  As expected, many of those  who got the placebo felt less pain, whereas the naloxone group felt miserable, as their own natural opioid (endorphin) generator was being blocked.  When naloxone was given to the genuine placebo group, they also felt miserable.  So this study does show that pain placebos work because the brain self-medicates with the opioid like drug endorphins.