THE PLACEBO EFFECT PART 2

POTENTIAL FOR THE USE OF PLACEBO EFFECTS

IN PHYSICAL THERAPY (PART 2)

of a treatment may be very important to the patient and be the difference between a fast and effective recovery or a condition that endures.

What must be made clear is that the placebo effect is not a ‘stand alone’ phe- nomenon. Certainly it may stand alone in instances in which an inert substance is given, for example, to reduce a patient’s pain. But in most instances, for reasons of ethical, biological or pragmatic impera- tive, this does not happen. A more likely scenario is that the biological/pharmaco- logical qualities of an active painkiller may be enhanced by the beliefs and expectations of the patient (it should be noted that by implication, such inherent biological/pharmacological qualities may be reduced by negative beliefs of the patient, the ‘nocebo effect’). There is a definite synergistic action between the active treatment, the patient’s beliefs, and the practitioner’s beliefs. On the evi- dence above, it could be suggested that if

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Conditioning Physiotherapists are associated with recovery

Physiological theory Endorphins/pain reduction

Outcomes related to expectations

Experimenter bias Physiotherapist expects me to recover

Patient expectations

Reporting error

I feel better because I am going to the physiotherapist

Anxiety theory I expect to recover and therefore am less anxious

Expectancy theory I expect to get fitter

Cognitive dissonance I have invested a lot in this

Figure 1: A model of patient’s beliefs and potential outcomes (Figure adapted from Ogden (2) (2000))

a patient believes and expects that a par- ticular treatment modality (eg. ultrasound) will have a beneficial effect on their symp- toms, it should be administered anyway even if the practitioner believes it will pro- vide no physiological benefit for the heal- ing tissue (although clearly the practition- er must not convey this sentiment to the patient), as long as it is not contraindicat- ed for the injury or stage of healing.

Figure 1 portrays some potential pathways for placebo effects. Several of these (for example, cognitive dissonance theory) are compelling but beyond the scope of this article. We recommend that interested practitioners read Evans’ text (1) and Ogden’s (2) overview for further details. However, derived from the sections above, some tentative recommendations for prac- tice can be made. Please note that these

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