Use of placebo effect, or cues to your body that you are taking a medicine

[Hugo]

When I drink a cup of coffee the caffeine works nearly right away or atleast in a couple of minutes. This is not true though since caffeine takes longer time to have an effect and I notice the much longer time for it to have an effect when I use caffeine pills (like 20 minutes). Even though I taken a couple of pills in my days it will not have a faster effect when I take the pills now than before.

This seems to indicate that this is behavioural conditioning placebo regarding coffe since then I (my body) knows the look, taste and smell of coffee and what it does to my body. I think my body somehow then starts to mimic the effect of caffeine. It does not do that with caffeine pills since its just my knowledge that the caffeine pills work the way it does but no visual, smell and taste cues, its just a small white pill like every other pill.

This effect has some studies to back it up, but I wonder if anyone here used this effect to maybe strengthen the effect of a medicine. For example taking a pill with a colorful fluid that taste unusual (like a combo of different spices) and have a special smell?

 

[Mohawk1995]

@johmil You bring up something that is controversial and yet what you say has merit to it. How we think can change the actual physiology of our brain. This is particularly true if the thought pattern is of an intense nature and/or is sustained for a lengthy period of time.

Placebo is real and it is physiological (not merely a psychological phenomenon). A thought is physiology after all. It is most effective for processes that are highly neurophysiological such as Pain, Alertness, Fatigue, etc... It is limited though and should never be the primary form of treatment. This is especially true in severe systemic diseases such as ME/CFS. It is not a powerful enough effect to overcome these disorders, although it may play a factor in them. It is also not something the patient can "make happen".

In Physical Therapy which often is addressing pain issues, it is the wise therapist who sets up a positive environment, explains everything in detail to the patient and occasionally uses "the bling factor" to help the patient recover. This is not unethical, it is just good medicine. Being a PT myself, I have knowingly and unknowingly relied on this to help the patient. I am sure there are other ways to do so in other areas of medicine.

 

[Hugo]

@johmil You bring up something that is controversial and yet what you say has merit to it. How we think can change the actual physiology of our brain. This is particularly true if the thought pattern is of an intense nature and/or is sustained for a lengthy period of time.

Placebo is real and it is physiological (not merely a psychological phenomenon). A thought is physiology after all. It is most effective for processes that are highly neurophysiological such as Pain, Alertness, Fatigue, etc... It is limited though and should never be the primary form of treatment. This is especially true in severe systemic diseases such as ME/CFS. It is not a powerful enough effect to overcome these disorders, although it may play a factor in them. It is also not something the patient can "make happen".

In Physical Therapy which often is addressing pain issues, it is the wise therapist who sets up a positive environment, explains everything in detail to the patient and occasionally uses "the bling factor" to help the patient recover. This is not unethical, it is just good medicine. Being a PT myself, I have knowingly and unknowingly relied on this to help the patient. I am sure there are other ways to do so in other areas of medicine.

True, I would not think it could replace a therapy but possible enhance a therapy like the bling factors you write about. Its an interesting effect and would probably be strongest in certain meds (hormones and immunesystem for example) but not in antibiotics for example.

 

[Valentijn]

Placebo is real and it is physiological (not merely a psychological phenomenon).

Research has shown that placebo doesn't have a physiological impact on the biomedical condition which it pretends to treat. Even if thoughts do have any significant impact on the structure of the brain (debatable), that clearly does not get passed on to elsewhere in the body.

 

[trishrhymes]

I guess it's possible that when you drink coffee some caffeine may be absorbed in the mouth, straight into the blood, so have a pretty rapid effect, whereas when you take a pill it has to get digested in the stomach and then absorbed into the blood, so it might take longer. I wonder what would happen if you chewed the caffeine pill. Some drugs are designed to be dissolved in the mouth and they work very fast.

 

[Hugo]

I guess it's possible that when you drink coffee some caffeine may be absorbed in the mouth, straight into the blood, so have a pretty rapid effect, whereas when you take a pill it has to get digested in the stomach and then absorbed into the blood, so it might take longer. I wonder what would happen if you chewed the caffeine pill.

Dont think so, the effect is rather strong and I even had in decaf even without knowing it was decaf (it has some small amount of caffeine in it but it would hardly have any effect).

 

[barbc56]

Research has shown that placebo doesn't have a physiological impact on the biomedical condition which it pretends to treat. Even if thoughts do have any significant impact on the structure of the brain (debatable), that clearly does not get passed on to elsewhere in the body.

That's an important point. For example this study:

Placebo Improves Asthma Symptoms, But Not Lung Function

As expected, patients reported symptom relief with the albuterol treatment. However, they also felt similar improvement when using the placebo inhaler or the sham acupuncture. When the team looked at the maximum air volume that patients could exhale, they found improvement in lung function only when the patients received albuterol. There was no improvement in objective measurements with the other treatments.

While the authors stress that their results will need to be replicated, they note that these results suggest the ritual of treatment itself can reduce patients’ perceived symptoms, even when their illness actually remains the same. Therefore, if doctors want to truly measure improvement in patients’ asthma, it is important for them to use an objective measurement.

My bold.

 

[pamojja]

https://en.wikipedia.org/wiki/Placebo#Chronic_fatigue_syndrome

Chronic fatigue syndrome
It was previously assumed that placebo response rates in patients with chronic fatigue syndrome (CFS) are unusually high, "at least 30% to 50%", because of the subjective reporting of symptoms and the fluctuating nature of the condition. According to a meta-analysis and contrary to conventional wisdom, the pooled response rate in the placebo group was 19.6%, even lower than in some other medical conditions. The authors offer possible explanations for this result: CFS is widely understood to be difficult to treat, which could reduce expectations of improvement. In context of evidence showing placebos do not have powerful clinical effects when compared to no treatment, a low rate of spontaneous remission in CFS could contribute to reduced improvement rates in the placebo group. Intervention type also contributed to the heterogeneity of the response. Low patient and provider expectations regarding psychological treatment may explain particularly low placebo responses to psychiatric treatments.[130]

Well worth reading the whole article for more perspectives to it. But much worse and essential noticing is it's opposite, the Nocebo Effect:

https://en.wikipedia.org/wiki/Nocebo

Writing from his extensive experience of treating cancer (including more than 1,000 melanoma cases) at Sydney Hospital, Milton (1973) warned of the impact of the delivery of a prognosis, and how many of his patients, upon receiving their prognosis, simply turned their face to the wall and died a premature death: "... there is a small group of patients in whom the realization of impending death is a blow so terrible that they are quite unable to adjust to it, and they die rapidly before the malignancy seems to have developed enough to cause death. This problem of self-willed death is in some ways analogous to the death produced in primitive peoples by witchcraft ("Pointing the bone")." (p.1435)

 

[Mohawk1995]

@pamojja "According to a meta-analysis and contrary to conventional wisdom, the pooled response rate in the placebo group was 19.6%, even lower than in some other medical conditions."

From physiological perspective that makes complete sense (even without a Nocebo Effect). ME/CFS is a deeply entrenched and systemic metabolic, bio-molecular, Biochemical and Neurophysiological disease. If Placebo's impact is primarily Neurophysiological which many believe to be the case, then it is a far too weak phenomenon to change significant disease states like ME/CFS. It may be helpful as an "enhancer", but not as a primary treatment mode.

 

[pamojja]

However, if nocebo negatively affects even cancer, I personally choose not to give it any foothold.

 

[Hutan]

There are a number of reasons why a coffee might have a different and quicker effect than a caffeine pill.

First there is heat, which will speed any biological processes involving the caffeine or other possibly biologically active compounds in the coffee. It will also dilate blood vessels and this will have an impact on circulation which may help to move the caffeine around your body and perhaps have some (fast acting) benefits of its own. Many cultures make hot drinks (of varying sorts) a regular part of the day - perhaps it's not just the caffeine that is useful.

Coffee helps ease asthma symptoms by relaxing airways and reducing the response to irritants. That response, including increased oxygen absorption, might help you feel better. I think the caffeine does need to be metabolised so it won't be an instant 'first sip' kind of response. But, I expect you don't scull your hot coffee. Maybe it takes 15 minutes or so to sip your coffee and that might be long enough.

As @trishrhymes suggested, there will be some absorption through the lining of the mouth. Also the caffeine in the steam may be absorbed directly through nasal tissue. e.g.

The interesting advantage of nasal drug delivery is the possibility of targeting central nervous system (CNS) by bypassing blood brain barrier[3] (BBB). The drugs absorbed nasally via olfactory epithelium are reported to enter in olfactory neurons and supporting cells and subsequently into the brain, which reduced not only the systemic toxicity of centrally acting drugs but also enhanced therapeutic efficacy.

(I was going to suggest (facetiously) that you could just sniff or even snort your coffee. But, there's an enhanced product for that!!
Turbosnort!! (not a recommendation)
http://www.prweb.com/releases/2011/11/prweb8996917.htm)

Turbo Snort is a naturally caffeinated formulation that is fortified with the popular performance amino acids creatine, taurine and glutamine. Because the ingredients are delivered up the nose and absorbed through the blood-brain barrier, only tiny doses are needed for maximum results. Since the active ingredients don’t have to travel through the body, the effects are instant and long lasting.

Then there's the water intake. That will increase the rate of absorption of the caffeine and possibly other bioactive compounds in your drink. It might also have benefits of its own, although perhaps not immediate.

I think there are enough possible physiological mechanisms for what you are noticing that you don't have to conclude yet that it's a placebo effect.

 

[Hugo]

There are a number of reasons why a coffee might have a different and quicker effect than a caffeine pill.

First there is heat, which will speed any biological processes involving the caffeine or other possibly biologically active compounds in the coffee. It will also dilate blood vessels and this will have an impact on circulation which may help to move the caffeine around your body and perhaps have some (fast acting) benefits of its own. Many cultures make hot drinks (of varying sorts) a regular part of the day - perhaps it's not just the caffeine that is useful.

Coffee helps ease asthma symptoms by relaxing airways and reducing the response to irritants. That response, including increased oxygen absorption, might help you feel better. I think the caffeine does need to be metabolised so it won't be an instant 'first sip' kind of response. But, I expect you don't scull your hot coffee. Maybe it takes 15 minutes or so to sip your coffee and that might be long enough.

As @trishrhymes suggested, there will be some absorption through the lining of the mouth. Also the caffeine in the steam may be absorbed directly through nasal tissue. e.g.


(I was going to suggest (facetiously) that you could just sniff or even snort your coffee. But, there's an enhanced product for that!!
Turbosnort!! (not a recommendation)
http://www.prweb.com/releases/2011/11/prweb8996917.htm)


Then there's the water intake. That will increase the rate of absorption of the caffeine and possibly other bioactive compounds in your drink. It might also have benefits of its own, although perhaps not immediate.

I think there are enough possible physiological mechanisms for what you are noticing that you don't have to conclude yet that it's a placebo effect.

Maybe, but the heat is a cue aswell. I mean that I have effect very fast from the first zip.

I suppose its easy to test.. I suppose caffeine is a polar molecule and it would dissolve in water so if I use caffeine powder in a cup of warm water it would be the same as coffee.

 

[Skippa]

There are other things in coffee besides caffeine which all add up to make a "package of symptoms" when drinking it.

For example, decaffeinated coffee can still stimulate the GI tract.

 

[Effi]

Also, decaf-coffee is not 100% free of caffeine.

 

[Izola]

"This seems to indicate that this is behavioural conditioning placebo regarding coffe since then I (my body) knows the look, taste and smell of coffee and what it does to my body. I think my body somehow then starts to mimic the effect of caffeine. It does not do that with caffeine pills since its just my knowledge that the caffeine pills work the way it does but no visual, smell and taste cues, its just a small white pill like every other pill."

Perhaps Classical conditioning, as in, e.g., Pavlov's dog.
iz