Issue link: https://www.massageandbodyworkdigital.com/i/992435
A B M P m e m b e r s e a r n F R E E C E a t w w w. a b m p . c o m / c e b y r e a d i n g M a s s a g e & B o d y w o r k m a g a z i n e 83 The setting and context of treatment are types of "placebos" that have clear influences on outcomes. Patients who stay in hospital rooms with natural views have lower pain-medication use, shorter postoperative stays, and rate their nursing staff higher. "A placebo is the entire ritual of the therapeutic act," not just the sugar pill, says Benedetti. 2 After all, sugar pill placebos only "work" when offered within the context of a therapeutic interaction. From this perspective, it is the treatment's context itself—including the setting; the interaction between practitioner and client; the client's expectations, beliefs, and conditioned responses; and more—that are the "active ingredients" in the placebo intervention. Dramatic examples of therapeutic context influencing treatment outcomes abound. For example, studies of contextual placebo factors (such as setting, interaction, expectations, etc.) have shown that: • Warmer, more empathic practitioners get better results (Images 1–2). In one 2014 study, chronic back pain patients reported a greater reduction in pain (55 percent) from placebo treatment given by an empathetic practitioner than from actual back pain treatment given by a noncommunicative practitioner (46 percent). 3 • Hospital rooms with views of nature (Image 3) have lower analgesic use, shorter postoperative stays, and higher patient ratings of their nursing staff. 4 • In a study of factors affecting recovery from back, knee, and shoulder injuries, the strongest predictor of successful recovery was the patient's expectations about that recovery. 5 • More patients with favorable expectations about their sciatica-related surgery had good outcomes than did those who had unfavorable expectations; even more interesting, the patients' expectations about recovery were an even stronger predictor of success than the surgeons'. • Practitioners' confidence and expectations have their own placebo effects as well: when clinicians thought they were giving a placebo (when actually giving pain 3 medication), their patients reported less relief compared to those whose doctors knew they were giving active pain medication (see "The Value of Confidence," Massage & Bodywork, March/April 2018, page 102). 6 These examples remind us, as manual therapists, that there are many things that influence our results besides our hands-on methods themselves. Our practice room, demeanor, rapport, language, fostering of accurate expectations, and confidence in our own methods all have the power to help or hinder our work, in and of themselves. As the examples above show, placebo responses can be related to conscious expectations, meanings, or beliefs, but those are just some of the ways placebos work. Strangely enough, you don't have to believe in a treatment, nor trust your practitioner, to have a significant placebo response. Our brain's conditioned responses, which