All in the mind

Renowned orthopedic surgeon David Hanscom came to the conclusion reached by many of his colleagues in their quiet moments: spinal surgery wasn’t helping his patients, but mostly making them worse.  

He then embarked on a radical way of treating his patients that eschewed surgery and focused on where pain—and healing—starts and ends: in the mind itself.

Paradigm-shifting new scientific research has now verified what we’ve long seen in our work: that most of the benefit you get from a drug or a placebo has to do with just the thought about getting medicine, and not the drug itself.  

This was the conclusion of the largest meta-analysis review of brain placebo research from an international consortium of university researchers, led by Tor Wager, a distinguished professor and the principal investigator of the Cognitive and Affective Neuroscience Lab at Dartmouth University.  

The research team examined and pooled results from some 20 studies involving a total of 600 healthy participants who’d agreed to have “evoked pain” administered (they were exposed to some stimulus causing pain). They were then given a pain relief pill that, unbeknownst to them, was actually a placebo, a dummy pill with no active pain-relieving ingredients.

In all the studies in the review, the vast majority of those given placebos reported feeling less pain.

But the question for the Dartmouth team was how this all worked. Did receiving a placebo actually lower  the body’s experience of pain, or simply change how a person thinks about pain after the fact because they’ve received a medication? 

In other words, does a placebo actually work, and not only in the mind but also in the body?

Researchers then tracked what was happening in the brains of those who took a placebo using whole-brain imaging equipment, which had not been possible before.

According to Wager, “Our findings demonstrate that the participants who showed the most pain reductions with the placebo also showed the largest reductions in brain areas associated with pain construction.” 

Although science is still learning about how the body assembles an experience of pain, it appears to involve a host of brain areas that help to activate motivation and decision-making. 

As he and his team discovered, the placebo had a complex effect.

They managed to isolate major placebo effects on specific portions of the brain involved with pain, including parts of the thalamus, the doorway for all sorts of sensory input like sights and sounds; the somatosensory cortex, involved in the first experience of pain; the basal ganglia, which link the pain to motivation and action (what you are going to do to alleviate the pain); and, perhaps most importantly, the posterior insula, an area in the brain centrally involved in the entire sense of pain.   

In other words, receiving a sugar pill and thinking that it’s a pain analgesic dampens down our sense that we’ve been hurt, the ‘pinch’ of the hurt itself, our ‘ouch’ reaction, our sense that we are feeling an ‘ouch’ and our decision about how to stop the pain.

This is an explosive finding. Wager’s team is the first to show that a placebo actually physically changes entire brain circuitry.

Just the thought of pain relief, even if not based on true medicine, can turn off the entire mechanism involved with pain. 

But the reverse is also true, as discovered by Ted Kaptchuk, a professor of medicine at Harvard Medical School. In one study, he and his colleagues gave patients with severe carpal tunnel syndrome either pain pills or acupuncture.  

One-third of his 270 patients complained of side-effects so severe they couldn’t get out of bed, with pain reaching almost unbearable levels.  

But among the other patients, most reported great pain relief, with those receiving acupuncture reporting the best outcomes.  

But the extraordinary thing about the study is that nobody actually received any real treatment. The ‘pain pills’ were just made of cornstarch, and the acupuncture needles were retractable sham treatments that never pierced the skin.  

Just the thought of the treatment triggered major side-effects in some people and major healing in others. 

The key to whether someone gets better or worse, Kaptchuk says, is how the medicine and medical information get delivered: whether the practitioner is caring or matter-of-fact, and how well they frame answers to questions or aids in the patient’s perception of treatments.   

Our close friend Shelly was suffering from chronic and debilitating back pain so severe that she occasionally contemplated suicide.  

At the height of her suffering, her brother, a psychologist, told her to give her pain a new nickname whenever it appeared: ‘Squeaky,’ or ‘Shouty’ or whatever best described it in her mind. Then, he said, she was to forget it—to think about something else. 

Shelly did just that, and a miracle happened. Her pain went away and has never come back.

All of which demonstrates that the mindsets of both practitioner and patient are central to healing and probably most drug activity. And, Dr Hanscom came to realize, it’s also the key to overcoming pain of all varieties.

In other words, as Dr Larry Dossey once wrote, it’s all about the practitioner’s healing words, but also when it comes to the patient maintaining healing thoughts.