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A New Understanding Of Chronic Pain : The Free Energy Principle And Body Awareness

July 2, 2018

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Placebo and the art of healing

 

Pain, just like nausea and vomiting or fever is not a primary problem for the body, but a response to a threat to the body. In the case of pain, it alerts the individual to a wound or injured area and therefore encourages care to keep the area clean or to not use an area until the injury has healed enough to allow movement. Vomiting tries to empty the stomach of something perceived as threatening to body, and fever attempts to heat the body up to a temperature that will kill pathogens causing illness.

 

Although each is uncomfortable to live through, they are vital tools to our survival. However, they all are costly. For example a mild fever can increase the energy demands of the body by 15%. As Nehemiah Grew, an anatomist in the early 18th century noted "That which threatens death tends, in conclusion, to the prolonging of life".

 

Evolutionary biologist Nicholas Humphrey puts forward the theory that our early ancestors would often have had limited resources of food and their systems (both in and outside of their conscious control), would have needed to assess the benefits of mounting a costly healing response against delaying it until there were improved circumstances. For example waiting until there were more food available, or perhaps people to help, or indeed risk of further infection. 

 

Studies have shown that if hamsters are given an infection in what they believe is winter they will keep it in a holding condition, whereas if they believe it to be summer they mount an immune response.  If you think about all those bugs that you cannot shake off for weeks over the winter months you can see we appear to have the same evolutionary responses. Our brains have not had an update and still believe we are running around on the Serengeti and have limited access to food and need to be very careful how we spend our energy resources (which may also explain obesity - if we have a chance to store food by overeating we will go for it!).

 

Placebo, Humphrey believes, originates from  the individual being given permission by another to mount a healing response. This may be because others are present to help, or a shamanic healer could perform an act of healing, or any other cultural or environmental cues that healing can occur, such as the presence of food.Indeed it is believed by many that Stonehenge was a placebo hospital where people would travel to touch the stones to encourage healing.

 

Today this healing can be through a child receiving a kiss from their mother, or taking a pill that you have learnt to believe is good for you. However this is not just through working areas of the brain that deal with reward,which in terms of our evolution are new (the cortex) but areas of the brain that are ancient and are built around conditioning.  People with Parkinsons disease, which is a problem arising from deep within the brain, can improve their  movement if they are given a tablet that looks like their Parkinsons medications, when it is in reality a dummy or placebo tablet.In fact in modern medicine, sham knee operations work as well as real operations, salty water squirted into a painful joint works as well as a steroid and many modern medications have trouble beating a placebo medicine.This has also been shown with acupuncture trials, with sham needles (they do not pierce the skin, though the patient is unaware of this) working as well as real acupuncture.

 

Scott Miller, a psychotherapist researcher,shows that in the United States today, more people  consult and give money to healers and mystics, than seek help from qualified mental health practitioners who practise evidence based medicine. He also notes that there are a recognised group of "supershrinks" in the psychotherapy profession who have much greater results for their clients than other practitioners. This is not related to experience, age, sex or education, but their ability to form a strong bond with their clients, known as the therapeutic alliance. They also have the skill to form this alliance with a wide range of people from varied backgrounds. He compares this to "mentalists" a term for people who have the ability to "read minds" and perform hypnosis and can form very strong bonds with someone they have met within seconds by appearing to know intimate facts about them.

 

It seems that this need to look for magical care is deeply ingrained. I am an "evidence based" osteopath, who attempts to give care based on scientific understanding. However there is also undoubtedly an art to giving care, which rubs against this stance. But I believe the two can live together. Firstly giving hope is a powerful tool, we need to feel there is a way out of our problems and I truly believe that almost everyone with chronic pain can benefit from treatment that creates hope of positive change. I also practise hypnotherapy, which has the benefits of having possibly the best evidence base of all the complementary therapies, but also works by firstly  creating a calm, focused mind, which is then is open to positive suggestions for change. This is both scientific and in my mind has an element of "magic" in the mix. Giving hypnotherapy to a client is a rich experience for both the client, but also the practitioner. In fact there is evidence that therapists tend to get the same neuroimmune changes as their client.

 

If you are looking for change from your pain and suffering, whether it is physical or emotional, please book yourself in for an appointment. Perhaps some magic can happen!.

 

Main Sources

 

https://www.psychotherapynetworker.org/magazine/article/1077/how-psychotherapy-lost-its-magick

 

http://www.humphrey.org.uk/

 

www.newscientist.com/article/mg21528812-300-evolution-could-explain-the-placebo-effect/

 

https://en.wikipedia.org/wiki/Health_management_system#Placebos

 

https://www.ncbi.nlm.nih.gov/pubmed/16721750

 

http://articles.mercola.com/sites/articles/archive/2014/02/07/arthroscopic-knee-surgery.aspx

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