Archive for year: 2017

Kaptchuk offers some ideas about what the key factors might be in the placebo effect (i.e. in positively enhancing healing, but not from the material effects of the treatment or drug). He suggests it is the effect of hope, attention and care; and to do with the social, not just their personal, beliefs i.e.(Pygmalion effect)
In turn that suggests these points:

• It has been established that persistent stress (unlike sharp, but passing, shocks) reduces immune system function. One service which doctors can perform is to tell a patient that they will recover. This is often not at all certain to the patient and their family. One of the reasons for mental illness being frightening to most people, is they don’t believe it will pass: this is in strong contrast to flu, food poisoning, broken bones, where they know they will recover. The assurance relieves anxiety and stress, which in turn improves immune system functioning, and so recovery.
• Thus it could be that inducing a patient (and those around them) to care for themselves is sometimes a key factor, and the basis for real healing effects independent of material interventions. This thought is further supported by the consideration that today in developed countries, the leading causes of death (heart disease, cancer) are thought to be largely controlled by lifestyles that the patient, not doctor, controls: persuading patients to behave differently is the key to controlling mortality.

Bagnato GN et al Rheumatology (Oxford). 2016 Apr;55(4)

This was a scientifically rigorous test of wearable pulsed electromagnetic fields (PEMF) for older patients with osteoarthritis of the knee: moderate to severe cases with X-ray evidence and pain of at least 4/10 for more than six months, despite maximum tolerated medication. PEMF is particularly easy to test properly, because it causes no sensation, making it much easier to compare to an active placebo. The placebo devices do not emit a radiofrequency electromagnetic and the active device cannot be distinguished in any way from the placebo device.

Their pain and knee function were compared. PEMF won decisively: the real-PEMF patients enjoyed a 25.5% reduction in pain, compared to a 3.6% reduction for the fake-PEMF patients. Knee function improved as well, though not as much.
The authors explain that “some of the effects of this therapeutic approach might be derived from neuromodulation of the pain mechanism”: that is, it might be “just” a pain-killer, as opposed to actually helping to heal arthritic cartilage.

Seffinger MA et al Spine Oct 2004

OBJECTIVES:
To determine the quality of the research and assess the interexaminer and intraexaminer reliability of spinal palpatory diagnostic procedures.

SUMMARY OF BACKGROUND DATA:
Conflicting data have been reported over the past 35 years regarding the reliability of spinal palpatory tests.

METHODS:
The authors used 13 electronic databases and manually searched the literature from January 1, 1966 to October 1, 2001. Forty-nine (6%) of 797 primary research articles met the inclusion criteria. Two blinded, independent reviewers scored each article. Consensus or a content expert reconciled discrepancies.

RESULTS:
A higher percentage of the pain provocation studies (64%) demonstrated acceptable reliability, followed by motion studies (58%), landmark (33%), and soft tissue studies (0%). Regional range of motion is more reliable than segmental range of motion, and intraexaminer reliability is better than interexaminer reliability. Overall, examiners’ discipline, experience level, consensus on procedure used, training just before the study, or use of symptomatic subjects do not improve reliability.

CONCLUSION:
The quality of the research on intra reliability and intra reliability of spinal palpatory diagnostic procedures needs to be improved. Pain provocation tests are most reliable. Soft tissue paraspinal palpatory diagnostic tests are not reliable.