Chronic Pain and the Placebo Effect with A. Vania Apkarian, PhD
Chronic pain, such as lower back pain that lasts for months or years, affects 100 million Americans and costs half a trillion dollars a year in healthcare costs. It is also contributing to the current opioid crisis. A. Vania Apkarian, PhD, explains his recent discoveries related to chronic pain and how placebos may be a very effective option for some.
"The ones who are responding (to a placebo), they have a pain relief of about 30 percent. That number is important, because 30 percent is clinically significant and it is comparable or even superior to any drugs out on the market that we sell to these patients."
— A. Vania Apkarian, PhD
Chronic pain is a complicated issue, and it's been controversial for a long time. The simplest definition is pain that persists for more than three months, that you cannot control, A. Vania Apkarian says. Lower back pain is the most common form of chronic pain. Apkarian’s team have spent decades studying subjects with chronic lower back pain
Apkarian: “(Lower back pain) is the number one disability condition in the U.S., considering all other health conditions, it is the number six disability condition worldwide. So, the scale of the disability is massive. Fortunately it doesn't kill people, but it definitely disables people. It impacts quality of life.”
The World Health Organization has stated that no one treatment is best for chronic lower back pain. Drug therapies, surgical procedures, alternative medical procedures, exercise and yoga all seem to have the same impact on pain reduction. In the U.S., opioids are commonly used to treat lower back pain, mostly because they have an immediate effect, but opioids can come with longterm, non-beneficial outcomes.
Apkarian: “The chronic pain population itself is a major source of opiate addiction in this country. It is probably the primary medical source of opiate addiction in the country, and yet the science behind opiate treatment for chronic pain remains uncertain. It may help some people; it may not help a large majority of others.”
For some, a placebo my be more effective. In a recent study, Apkarian and his team showed that they can reliably predict which chronic pain patients will respond to a sugar placebo pill based on the patients’ brain anatomy and psychological characteristics.
Apkarian: “In a sense, both personality and brain anatomy and brain functional properties, the amount of information these people exchange across brain areas, all of them are uniquely different between those who are responding to the placebo pill and those who are not responding. The ones who are not responding don't show any response at all. The ones who are responding, they have a pain relief of about 30 percent. That number is important because 30 percent is clinically significant and it is comparable or even superior to any drugs out on the market that we sell to these patients.”
Apkarian says the findings could change the way the scientific community understands the placebo effect and could give certain chronic pain suffers a break from medication. He recently received a grant from the National Institute on Drug Abuse to establish a center for chronic pain and drug abuse at Feinberg. One goal is to help identify people with chronic pain who are at risk of opioid addiction and explore other treatments, therapies and approaches to easing their pain.
A. Vania Apkarian has nothing to disclose.
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