The finding also will lead to more precise and accurate clinical trials for pain medications by eliminating individuals with
high placebo response before trials.
A new study finds that
rising placebo responses may play a part in the increasingly high failure rate for clinical trials of drugs designed to control chronic pain caused by nerve damage.
While such experiments aid understanding of the biological and behavioral underpinning of
placebo response in experimental (applied) pain, they translate poorly to the clinic, where pain is mainly chronic in nature, Baliki said.
«It might be that there is not one genetics
of placebo response but many, so that one person is responsive when it comes to pain, one when it comes to immune protection, and so on,» he says.
Study subjects took a drug or placebo pill with either water or the odd drink and the ones who got the placebo with the strange liquid had almost a stronger response as did the subjects who got the real drug, a far
bigger placebo response then the water drinkers got.
«American placebo: New analysis of chronic pain drug trials shows increasing
placebo responses over time, in the US only.»
It was the first
time placebo responses in Parkinson's disease had been definitively linked to a natural burst of dopamine.
These results show that only two shots of morphine, separated in time by as long as a week, are enough to induce a strong and long -
lasting placebo response, which could significantly boost pain tolerance in an athlete on the day of a competition.
The results also echo a long documented finding in depression treatment research across the age span — namely, that there is a high
placebo response rate, which can exceed 50 %.
«The data suggest that longer and larger trials are associated with
bigger placebo responses,» said Jeffrey Mogil, the E.P. Taylor Professor of Pain Studies at McGill and senior author of the new paper.
Medicine already recognizes the persuasive power of beliefs, as the authors point out; mindsets are at the root
of placebo responses, they say, and «may offer an explanation for the positive effects and physiological changes that are associated with inert pills or sham procedures.»
Hall was excited by this discovery of a potential biomarker
for placebo responses, especially because it suggests there may be many more.
The effect of CSMT was likely due to
a placebo response.
Surprisingly, however, the analysis of clinical trials conducted since 1990 found that the increase in
placebo responses occurred only in trials conducted wholly in the U.S.; trials conducted in Europe or Asia showed no changes in placebo responses over that period.
Similar increases in
placebo response have previously been observed in studies of clinical trials of antidepressants and antipsychotic drugs.
«The results of this study raise interesting questions about how this hormone differentially affects the biology of
the placebo response in men and women,» commented Dr. John Krystal, Editor of Biological Psychiatry.
Currently,
placebo response is primarily studied in healthy subjects within controlled experimental settings.
If so, their brains should learn to mount
a placebo response without subjects» conscious awareness.
But scientists are increasingly recognizing
the placebo response as an authentic neurochemical reaction in the brain.
And Harvard University neuroscientist and placebo researcher Karin Jensen has found a way to elicit
a placebo response without giving patients any conscious expectation at all.
But her results for the first time establish a link between
the placebo response and a physiological event with a known genetic cause — namely, the flavor of COMT in a person's brain.
Wager's findings implied that the physiological stream of events involved in
placebo responses might be the reverse of what happens during the experience of pain.
Sparking
a placebo response usually requires doctors to dupe patients, withholding treatment while giving them the false expectation that they're getting the real thing.
And when people respond well to placebos, they show stronger activation in brain circuits that control pain compared with those who are less susceptible to
the placebo response.
This new discipline acknowledges that placebos and
placebo responses with their wide range of physiological responses involving numerous mechanisms across a number of conditions, systems, and interventions represent an active field of neurobiological research.
The usual thought is that big pharma design trials to favour their drugs and suppress
the placebo response.
«What surprised me the most was the strong link between this element of reward processing and the fact that you can predict
the placebo response,» Zubieta says.
The map could be useful for working out how much of a drug's effect is due to
a placebo response in clinical trials and for identifying good candidates for placebo therapy.
Tomas Furmark, a psychologist at Uppsala University in Sweden, suspected that a different neurotransmitter plays a role in
placebo responses to social anxiety disorder (SAD)-- an abnormal fear of being judged by others.
TPH2 is the first genetic marker tied to
any placebo response, the team reports.
The placebo response meta - analysis demonstrated that type of drug was the only factor significantly influencing the placebo response, opioid trials having a greater placebo response.
Another explanation: The size and length of the clinical trials in the U.S. were larger, factors associated with bigger
placebo responses, though researchers don't know why.
«What we're trying to do is boost
the placebo response to make drugs more powerful, or reduce the amount of medication someone might need because of their strong placebo response,» she says.
Her team combed extensively through the literature and identified «the placebome,» a network of genes that influence
the placebo response.
A drug could actually block a «good»
placebo response, says Hall, or it could enhance a placebo response.
«This is at some level getting at
the placebo response,» says Sean Mackey, MD, chief of the pain management division at Stanford University School of Medicine, in Palo Alto, Calif. «I don't want to suggest that we view acupuncture as a kind of voodoo magic.
Once you factor in
the placebo response, for every single person who improved from taking Rifaximin, ten did not get better.12