MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

An abstract from the recent ‘2nd OFFICIAL SIPS CONFERENCE ON PLACEBO STUDIES’ caught my attention. It is not available on-line; therefore let me reproduce it here in full:

The role of placebo effects in mindfulness-based analgesia 1. Jonathan Davies. University of Sydney, Sydney, NSW, Australia. 2. Louise Sharpe. University of Sydney, Sydney, NSW, Australia. 3. Melissa Day. University of Queensland, Brisbane, QLD, Australia. 4. Ben Colagiuri. University of Sydney, Sydney, NSW, Australia.

Background: Mindfulness meditation can reduce pain both in experimental and clinical settings, though it is not known to what extent mindfulness-specific vs placebo-like expectancy effects account for these changes. This study aimed to: 1. establish whether placebo effects contribute to mindfulness-mediated analgesia; and 2. identify putative cognitive mechanisms responsible for placebo- vs mindfulness-mediated analgesia. Methods: We compared the effects of focussed-attention mindfulness training (6 x 20 min), sham mindfulness, and a no-treatment in a double-blind RCT for experimental heat pain. Sham mindfulness instructions lacked the ‘active ingredients’ of the real training but were matched on all other contextual factors. Results: Both real and sham mindfulness training led to greater pain tolerance relative to no treatment, but there was no difference between the real and sham training. This was accompanied by increased expectancy, beliefs, and pain-related cognitive processes in the two mindfulness groups relative to no treatment, but again there were no differences between real and sham training on these outcomes. There were no effects on pain intensity, pleasantness or threshold. Conclusion: These findings suggest that mindfulness training – at least those involving focused-attention – may lead to improved pain tolerance via the placebo effect rather than any specific mindfulness-related mechanisms. Potential mediators of these effects will be discussed.

I find this study remarkable in two ways:

  1. It shows that, with a bit of fantasy, ingenuity and will, one can design and use sham procedures even in clinical trials of mind/body therapies.
  2. Its results suggest that, if one does control for placebo effects, these treatments may not prove to be more than a placebo therapy.

What implications might this have for clinical practice?

Mindfulness is currently hugely popular. It would not be surprising, if the news that it might rely purely on placebo effects would calm down the enthusiasm about this treatment. Many might ask, does it matter? As long as patients benefit, the mechanism of action seems irrelevant. This, of course, is an interesting debate which we have had on this blog many times before.

What do you think?

9 Responses to The role of placebo effects in mindfulness-based analgesia

  • They assert it “can reduce pain”, without explaining how thy know that, and then admit that they don’t know if it reduces pain. And by pain they mean reported pain. And by meditation, they mean reported meditation. And they don’t distinguish between the instructions for mindfulness and meditation itself. And they talk of the instructions for mindfulness as if there is a cause and effect relationship between giving the instructions and someone meditating. And they talk is if this relationship so clear that there can be a sham mindfulness which will produce a placebo effect. And they think the placebo effect is a real thing which exists and can be used as a tool for healing.

    So they don’t understand mindfulness or meditation, or the placebo effect, or how to conduct a study or how to write about the study.

    But apart from that, I don’t see any problems.

    • it’s only ab abstract!!!

      • Is the full text available anywhere or will it? We do know that pain receptivity is influenced by your mental state. The happier you are, the less affected you are by physical pain which is there. The more you are depressed, the more it affects you. Mindfulness meditation is not the only form of mental excercise that can give you increased happiness. So you could get the same pain relief from using other techniques, which aren’t even related to meditation, such as autogenic training or a myriad of others.

        There is a ton of research into the effects of meditation, and the gist is, that it doesn’t reliably lessen physical pain, but improves coping abilities, in particular with regard to chronical pain. For me, it has also been tremendously helpful in coping with tinnitus (which is of course chronic), even though the tinnitus itself hasn’t subsided. ( aside: I know of no mediation teacher who even promises that mindfulness/insight meditation will make your pain go away, so this seems a bit like a red herring)

        Also, every halfway competent meditation teacher will tell you, that meditation is not a substitute for therapy, not for medication, not even for antidepressants…

        Reasons for practising mindful meditation absolutely go far beyond the short-term effects which seem to have been at the center of research interest here, but that’s possibly for another day.

  • It matters if they’re charging you for the privilege of partaking of their placebos.

    • It is not like meditation teachers promise that mediation has an analgetic effect. It improves mechanisms for coping with pain, but it doesn’t make the pain magically disappear.

  • I understand, the paper is only looking into short-term effects, and that’s where I would say “sham instructions” can indeed work, as long as they instruct the meditator to focus their attention on *something* (below more on that). But I nonetheless would like to see these instructions “without the active ingredient”. Can you give an example of how the “active ingredient” was left out? I have been practising mindfulness/insight (vipassana) meditation for a decade, and I would say that there are two active ingredients in mindfulness meditation. One of them is of course mindfulness – paying close attention to what is happening in this very moment, to the raw data coming in through your sense channels.

    However, the other active ingredient is pure concentration. While mindfulness or vipassana is focused on actual sensations as they arise and pass away, there are other techniques, where you are instructed to imagine something, or to keep repeating certain phrases in your mind, such as in Metta (Loving Kindness) meditation, but one constant always remains: Your attention gets centered around something. As long as you have that part, you are likely to get the short-term benefical effects: A state of high concentration is indeed correlated with greater happiness, while the “a wandering mind is an unhappy mind” (see Matthew A. Killingsworth*, Daniel T. Gilbert: A Wandering Mind Is an Unhappy Mind, Science 12 Nov 2010: Vol. 330, Issue 6006, pp. 932, DOI: 10.1126/science.1192439).

    So unless the “sham instructions” didn’t instruct the meditator to keep checking their smartphones all the time or get distracted in other forms, positive results would be etirely consistent with “mindfulness-less” concentration.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you want to be able to edit your comment for five minutes after you first submit it, you will need to tick the box: “Save my name, email, and website in this browser for the next time I comment.”
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories