Attitude Adjustment

Attitude Adjustment

I have used several metaphors for the placebo effect: kissing a boo boo and beer goggles are my two favorite. Another would be attitude adjustment.

As I keep repeating, placebos alter the subjective experience but not the objective pathology.

This is shown in pain, as mentioned a few posts ago, where functional improvement occurs much less than subjective pain improvement with acupuncture.  What occurs with all effective placebos is an attitude adjustment: the patient thinks about their pain differently. 

Attitude adjustment is important with pain. JAMA this week published Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain

Given the high drop-out and the numerous data points tested, it is not surprising this study had some positive results. But the results are consistent with similar studies of placebo interventions. What they call "mind-body" in the accompanying editorial,

  • performed better than usual care.
  • was somewhat, but not impressively, helpful in alleviating subjective symptoms
  • was much less helpful in improving function.
  • had minimal effect on use of medication for back pain.

After reading the NICE guidelines for back pain, you get the real impression that there is little that actually helps chronic low back pain that is also inexpensive and without side effects. Teaching people to think about their pain differently may well be one of the key approaches in providing tools to relieve their pain. Perhaps Apple could help. Expectations and beliefs are important in helping people cope with pain, illness and stress of all kinds. The issue will be how to apply these interventions without resorting to pseudo-scientific and pseudo-medical interventions.

I have to admit to a bias against calling these interventions 'mind-body' as it sounds like there is some mystical component to the therapy. Outside of a Hank Williams Jr song, attitude adjustment probably would not fly as a name for these interventions. Perhaps we should call it Neibuhr therapy:

Medicine grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

Doing so does make life easier.

Points of Interest 03/30/2016
Points of Interest 03/26/2016