Posts Tagged ‘Pain’

Suggestible You 11

March 27, 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 eleventh post on this book. This post deals with depression.

Vance describes depression as like being chemically sedated into someone you don’t recognize.  He writes that given the choice, he might prefer excruciating chronic pain to depression, then goes on to note many people suffer from both.  He notes that about 7%  of Americans will experience clinical depression this year, losing the United States more than $200 billion.

It is clear that placebos are effective against depression.  Remember that to be declared effective the drug is compared against a placebo.  But when antidepressant drug tests are examined about 75% to 80% of their efficacy can be attributed to placebo effects.  Moreover, there was no real difference between high and low doses, which is odd.  Differences are expected with truly effective drugs.

Moreover, over the past few decals, scientists have noticed a distinct uptick in the power of the placebo effect on pain and depression trials.  Some experts even say that if Prozac had to compete against the placebo effect today, it would not have been cleared by the FDA.  Once a drug clears the Phase III, placebo-controlled trial, it is certified regardless of how it performs in later experiments.

For drug manufacturers trying to get new drugs approved, this is a problem.  But it should not be a problem for depression sufferers.  Remember the reason of including placebos in these tests is that placebo effects are real.  Placebos are much less expensive than the drugs, and carry no side effects.  HM wonders, as long as they are 75% to 80% effective, why take the drug.  Physicians should also be asking the same question.  Now it is clear why drug companies continue to try to develop new anti-depressants.  But after some many decades of research, with all the antidepressants already approved, and with placebos being largely effective without any adverse effect why bother.? At some point the difficulty in exceeding the effect of the placebo might prove so expensive that drug companies might abandon the effort.

© Douglas Griffith and, 2017. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and with appropriate and specific direction to the original content.

How Accurately Can We Predict Our Future Feelings?

August 12, 2015

This is an important question to ask as it affects the decisions we make.   This question was addressed in an article titled, “Wouldn’t It Be Nice?  Predicting Future Feelings” by George Loewenstein and David Schkade in the book, Well-Being:  The Foundations of Hedonic Psychology edited by Daniel Kahneman, Ed Diener, and Norbert Schwarz.

The chapter begins by stating three principles:
1.   People often hold incorrect intuitive theories about the determinants of happiness, which in turn lead to errors when predictions are based on them.
2.  Different considerations might be salient when predicting future feelings than those that actually influence experienced feelings.
3.  When in a “cold” state people often have difficulty imagining how they would fel or what they might do if they were in a “hot” state—for example, angry, hungry, in pain, or sexually excited.  It may also be the case that, when in a hot state, people frequently have difficulty imagining that they will inevitably cool off eventually.    Such “hot/cold” empathy gaps can lead to errors in predicting both feelings and behavior.

The authors also offer ideas as to why we typically fail to learn from experience.  “Learning from experience does not seem to offer a broad cure for prediction errors because intuitive theories are often resistant to change, memories of experiences are often themselves biased or incomplete, and experiences rarely repeat themselves often enough to make diagnostic patterns noticeable.”

Take the lottery, for example.  Many think that all their problems will be over if only they win the lottery.  Here are the results from winners of lotteries varying between $50k and $100k.  The average rating of their happiness was 4.0 on a 5.0 scale.   A control group of comparable individuals rated their average happiness as 3.82, suggesting that the lottery boozed their happiness by about 0.18.  Consider also the rated happiness of people who had experienced a disability from an accident, which was 2.96.  This result is typical.  We tend to overestimate the happiness that good things bring, and overestimate the sadness that bad things bring.  We tend to adapt to our conditions be they good or bad.

We also tend to over predict how fearful we shall be in potentially threatening situations.  For example, military trains undergoing parachute training over predicted they level of fear they experience on the first and most difficult jump.

Forty-four dental patients were interviewed both before and after dental a dental appointment.  On average, patients over predicted the degree of pain they would experience.  The mean expected level of pain was 16.5 and the reported actual level of experienced pain was 9.0.  The correlation between expected and experienced pain was 0.16, which is quite small.

We can also under predict pain.  A majority if expectant mothers stated a desire and intention not to use anesthesia  during childbirth, but reversed their prior decision when they went into labor.  This reversal of preference occurred among not only women giving birth for the first time, but also for those who had previously experienced the pain of childbirth.

There are also differences between healthy and sick people’s attitudes toward “heroic measures”  to extend the lives of the terminally ill.  Many healthy Americans, this healthy American included, state that we don’t want to die in a nursing home or hospital or, worse yet, an intensive-care unit, but 90 percent of dying patients, most of whom die in acute-care hospital, view the care they receive favorably.

In another study, different groups of respondents were asked whether they would accept a grueling course of chemotherapy if it would extend their lives by three months.  No radiotherapists said they would accept the chemotherapy, only 6 percent of the oncologists, and 10 percent of healthy people, but 42 percent of current cancer patients said that they would.   Another study found that 58 percent of patients with serious illnesses said that when death was near they would want treatment, even if it prolonged life by just a week.

The experienced quality of life of sick persons also appears to be underestimated.  In a study of 126 elderly outpatients with five common chronic diseases (arthritis, ischemic heart disease, chronic pulmonary disease, diabetes mellitus, and cancer) found that these patients generally rated their quality of life to be slightly worse than, “good, no major complaints.:

We are especially prone to mis-predict our behavior under temptation or duress.  See the health memory blog post “Good vs. Evil.”  We tend to overestimate the strength of our own willpower and to underestimate the influence of being in a hot state.  Included here are matters of sexual desire, drug craving, curiosity, the urge to spend, and hunger.

It would be good to conclude by presenting the results of the mean rang of different items with respect to producing happiness.

The importance of family life is most important, followed by friends, a satisfying job, and a high income.  It is noteworthy that income comes in last.  Obviously a certain amount of income is required for a satisfactory family life, but once a particular level of income has been reached, we do not become much happier.  $75k is the figure commonly cited and that will likely increase over time and be a function of circumstances.  However, beyond providing security and the basic comforts of life, it does not add much happiness.  I would argue that the pursuit of wealth is primarily a matter of ego and prestige, rather than living a satisfying life, per se.

© Douglas Griffith and, 2015. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and with appropriate and specific direction to the original content.

How Placebos Could Change Research and Practice

March 29, 2015

The title was on the cover of the April 2015 Monitor on Psychology of the American Psychological Association.  Inside the issue was an article by Stacy Lu, “Great expectations:  New research is leading to an understanding of how placebos work—findings that may lead to more effective treatments and better drug research.  Our understanding and attitudes towards placebos is advancing.

In one study neuroscience researcher Shaffer and his colleagues asked participants to apply a “powerful analgesic” on their hands and arms.  Then the researchers administered small bursts of heat where the cream had been applied.  The cream was actually petroleum jelly, but participants reported that the s-called powerful cream protected them from feeling as much of a burn  as a control cream.  Even after the researchers showed them that the active cream was just petroleum jelly, it made little difference.  The participants still reported less pain from the heat when they were re-tested versus the control cream (The Journal of Pain, 2015).

Today scientists are studying  placebos as a psychobiological  phenomenon and the placebo response as a potentially important part of the success of many medical treatments.  Psychological assessments, brain scans, and genotyping are used  to understand better how placebo responses work and to identify who may be most likely to respond to them.  Placebos are similar to cognitive therapies in that they tap into people’s beliefs that there’s hope and that they will get better.

A meta-analysis of 25 neuroimaging studies of pain and placebos conducted by Wager and Atlas of the National Center for Complementary and Integrative Health (NCCIH) found that people who took placebos and expected have reduced pain had less activity in brain regions associated with pain processing, including the dorsal anterior cingulate, thamalus, and insula (Handbook of Experimental Pharmacology, 2014).

Research suggests that placebos have the greater effect in neural systems involved with processing reward seeking, motivation, and emotion.  Placebos seem to work especially well in patients with depression, Parkinson’s disease, and pain.  All three conditions involve the neurotransmitter dopamine.  These are also areas where people can consciously monitor their own treatment results.

In a study of patients with Parkinson’s disease Wager and colleagues found that simply expecting medication altered brain activity in the striatum and ventromedial prefrontal cortex in brain areas associated with reward learning in ways similar to actual dopaminergic medication (Nature Neuroscience, 2014).

In another study of people with migraines, placebos elicited a response without any verbal cue to effectiveness,   Slavenka Kam-Hansen and colleagues openly labeled placebo pills for some patients who reported as much pain relief as those who also got a placebo but had been told that they’d received real medication. (Science Translational Medicine, 2014).

Genetics research has found that participants with a specific genotype related to having more dopamine in the prefrontal cortex reported having a larger effect from a placebo  treatment  than participants with a genotype that produces less dopamine in the prefrontal cortex (PLOS ONE, 2012).

Children seem to respond especially well to placebos.  In one study their placebo response was 5.6 that of adults (The Journal of Pain, 2014).

Patients are interested and enthusiastic about placebo  treatments.  They are pleased to discover that they can contribute to their own healing.

Brain Activity Underlying the Placebo Effect

August 21, 2013

Research that conducted brain imaging during placebo studies found that both the active (opiod) treatment and the placebo (saline) treatment activated the same network of brain regions. This included the brain stem, a part of the opiod system that mediates pain relief, and the rostral anterior cingulate cortex, which is rich in opiod receptors.1 It is also a part of the body’s reward system. The researcher, Petrovic, proposed that placebos, like opiods, triggered control areas such as the anterior cingulate that exerted control over the analgesic systems of the brain stem. The analgesic systems of the brain stem then released endorphins.

Another researcher, Tor D. Wager, who also used MRI found that additional brain systems were involved in the placebo effect. The researchers administered a placebo cream while giving painful shocks or painful intense heat on the forearms of the research participants. In one experiment a warning cue, a red “get ready” sign was given just before the painful stimulus was administered. The research subjects expected pain, unless the cream was applied, in which case they expected relief. The expectation of relief activated the cognitive executive center of the brain, the prefrontal cortex. Then the pain response areas of the brain declined, and the experimental participants reported relief. These results suggest that the placebo pain relief involves an expectaton signal from the prefrontal cortex that orders the midbrain to release opiods to meet the expectation of reprieve. Absent this, the full experience of pain is perceived. Further research has pinpointed specific regions of the prefrontal cortex as drivers.

Emotions are also involved in the placebo effect. Wager and his colleagues reported in 2011 that activities in regions of the brain that perform emotional appraisal, such as the insula, orbitofrontal cortex, and amygdala accompany a robust placebo effect. Wager calls this endogenous regulation. Placebos seem to give us a better perspective on our predicament. We might reevaluate our predicament so that we believe that the pain will abate and not cause persistent disability. According to Wager, during a placebo response, “our brain is likely doing a lot of the work without our real conscious input or even in spite of our conscious desires.” That is, we unconsciously engage brain mechanisms that serve to sooth.

Ironically, this self-soothing process might require us to focus on the pain rather than something else. In another study by Wager and his colleagues published in 2012, they tried to distract people away from experimentally induced pain by having them perform another task. This other task did not help relieve the pain. But when the researchers encouraged the participants to pay attention to the heat on their arm by asking them to rate its intensity, the participants experienced greater relief. This result is consistent with “acceptance” therapies or with the “relaxation response” in which people surrender to their pain to tolerate it better.

1The facts in this blog post can be found in an article, When Pretending is the Remedy, in Scientific American Mind, March/April 2013 by Trisha Gura.