Review: 'Through the Shadowlands’ describes Julie Rehmeyer's ME/CFS Odyssey
I should note at the outset that this review is based on an audio version of the galleys and the epilogue from the finished work. Julie Rehmeyer sent me the final version as a PDF, but for some reason my text to voice software (Kurzweil) had issues with it. I understand that it is...
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Use of placebo effect, or cues to your body that you are taking a medicine

Discussion in 'General Treatment' started by Hugo, Apr 3, 2017.

  1. Hugo

    Hugo Senior Member

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    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?
     
  2. Mohawk1995

    Mohawk1995 Senior Member

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    @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.
     
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  3. Hugo

    Hugo Senior Member

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    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.
     
  4. Valentijn

    Valentijn Senior Member

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    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.
     
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  5. trishrhymes

    trishrhymes Senior Member

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    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.
     
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  6. Hugo

    Hugo Senior Member

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    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).
     
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  7. barbc56

    barbc56 Senior Member

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    That's an important point. For example this study:
    My bold.
     
  8. pamojja

    pamojja Senior Member

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

     
  9. Mohawk1995

    Mohawk1995 Senior Member

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    @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.
     
  10. pamojja

    pamojja Senior Member

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

    Hutan Senior Member

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    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!! :lol::lol: (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.
     
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  12. Hugo

    Hugo Senior Member

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    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.
     
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  13. Skippa

    Skippa Anti-BS

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    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.
     
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  14. Effi

    Effi Senior Member

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

    Izola Senior Member

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    "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
     

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