Placebo Commentary

[Aaron Hartstein]

Hi guys,
This was in the recent issue of JOSPT and puts the context of our manual therapy techniques in an interesting light. I love the Indiana Jones metaphor that Bialosky uses throughout. Both Justin and Nic and I had instances where we discussed the implications of this last week. Take a look and see what you think.
Aaron

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[August Winter]

Interesting read. My small brain had to re-read it multiple times to appreciate some of the points he was making. After reading this my mind immediately goes to the “guru” practitioner that gets everyone better. Maybe their confidence, patient rapport, showmanship, etc. all contribute to the results they claim for a particular technique. I think this certainly adds another wrinkle to what might separate expert versus novice clinicians.

This article also highlights things we’ve already been aware of and have talked about before, with the importance of language and of patient expectation of improvement. Coupled with what we had briefly talked about with nocebo effects this weekend, I think it just continues to drive home the importance of effective patient-provider communication.

At the end of the day, analgesia is only one of the proposed benefits of MT, so while I think this article is good as a reality check for practice and research I don’t think it vastly changes my MT world view.

[Scott Resetar]

It’s all in the show!

I like the idea they present that the “show” could be a priming or placebo effect that then enhances the actual effect of MT, much like that currently being studied in enhanced rehab results after transcranial direct current stimulation, repeated transcranial magnetic stimulation, intermittent hypoxia, and ischemic conditioning.

I try not to bias my patient’s results when i re-assess by saying “did that make it worse” or just “better, worse, or the same?”. I will often say, in a joking way “Now, don’t lie to me! You can tell me if it’s the same, it still helps us in our diagnosis”

I think I get a more accurate response after that.

[Author]

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