Placebos are real
This statement may seem curious, or downright nonsensical. But, the meaning of this statement depends upon a full recognition of what placebo is. People often think of placebo as a thing 鈥� something like a sugar pill. Indeed, it is quite common to see reference to 鈥渁dministering a placebo鈥� or 鈥渢aking a placebo.鈥� But, this use of the term obscures important features of placebo, even to the point of losing some essential meaning. It is better to think of placebo in terms of a 鈥減lacebo effect鈥� 鈥� that is, producing a treatment effect by nontherapeutic means. In this way, placebo is not a thing, but rather a process. It is not that the sugar pill makes you feel better, but rather it is all the relevant experiences related to your ailment and the (purported) treatment that leads to a placebo effect (or not). A major component that drives a placebo effect is expectation. The old bromide, 鈥淚f you think it will work, it will work,鈥� is not completely true, but it is not completely false, either. The converse of this idea (largely only documented anecdotally) is that expecting a real treatment to not work can counteract its true effectiveness. The part that makes placebo real, especially in the context of pain relief, is that if indeed a nontherapeutic intervention does reduce pain, it is a real effect. Another testament to its 鈥渞eality鈥� are functional neuroimaging studies of brain activity when a successful placebo effect has reduced a person鈥檚 pain experience. Specific brain regions, recognized as having the capacity to blunt signals that represent a person鈥檚 experience of pain, are activated in conditions in which a successful analgesic placebo has been achieved. So a practical consideration derived from these observations is that gearing up your expectations for a positive analgesic effect will give you a better likelihood of a positive outcome than expecting no effect.
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