quote:Originally posted by MattP: When dealing with one person's back and a subjective symptom like "pain", there is absolutely no way to demonstrate whether something did or did not work.
Right. So please stop acting like you know what happened. It was demonstrated to me in that particular circumstance, which is all I am claiming.
Yeah, that's the same fuzzy thinking which leads people to say the exact same thing about homeopathy. "It was demonstrated to me in that circumstance that the homeopathic remedy completely fixed my back pain, which is all I am claiming."
In terms of the electrical stimulation (which really does not fix back pain; TENS units don't work for sciatica), all that has been demonstrated is that you're willing to believe that it worked because it was associated with a time period where alleviation occurred. Post hoc. It doesn't mean that the TENS unit was demonstrated to work on back pain, or your back pain. But you'll readily believe it works, which is the way stuff like Chiropractic and homeopathy is perpetuated even where and when you are receiving completely useless treatments.
This is really just a gloss over of what I've already described for you; does it make more sense now?
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You refer to a "time period". That "time period" was minutes. I went from not being able to move without pain to no pain. Right then. Again, I am curious as to how you know so much more about TENS units (which are still controversial) and my particular experience than my doctor (by which I mean the MD who sent me to the chiropractor) and the insurance company. Or about what I expected to happen.
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I have access to the same publicly available information on the efficacy of these treatments. Whether I know more or less than him on this particular subject is really just a matter of how much of that literature the two of us have read. As an MD, he hasn't necessarily been exposed to any more of that information than I have.
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I'm not sure why it would be necessary that MattP knows more than the doctor. As the article indicates, roughly 9% of doctors have prescribed placebos while outright lying (with a certain much larger but unspecified number using more creativity).
There's no reason why the doctor couldn't have sent a patient to the chiropractor knowing full-well that there is only a placebo effect at work.
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quote:Originally posted by kmbboots: It wasn't a case of you not making sense.
You refer to a "time period". That "time period" was minutes. I went from not being able to move without pain to no pain. Right then.
If it's not a case of you not making sense, it's a case of me being right about empirical study — and reality — and you being a classic case of someone who experienced the wonder of placebo and have turned it into you really wanting to be convinced that what you experienced was not placebo. After all, it's your back, right? And it all happened RIGHT THEN. How is anyone else supposed to know better?
When Peter Popoff put his hand on a person's forehead after being told by the Lord what their ailment was and healed them in the name of the Lord and chased the Devil out, they were absolutely certain that they had lost all their pain. Women crippled by arthritis would stand and walk! It was all such a miracle! It had all happened. Right then. Popoff was a fraud with a radio receiver in his ear, but it sure didn't seem to matter!
And let's talk a little bit more about why I'm sure about what TENS units actually do; it's because I understand medical research and the placebo effect, and I understand how susceptible people are to placebo and how much they want to be tricked.
quote:If you do much study into TENS you will find that it falls into a category of pain relief modalities known as hyperstimulation analgesia. These hyperstimulation treatments include such things as acupuncture, acupressure, massage and vibration and all have one thing in common. They all produce about the same pain relief results as a placebo.
A study published in the New England Journal of Medicine in June 1990 casts considerable doubt upon the effectiveness of TENS. The study found "that for patients with chronic low back pain, treatment with TENS is no more effective than treatment with a placebo, and TENS adds no apparent benefit to that of exercise alone."
And most recent studies all seem to confirm this assessment:
quote:There were no statistically significant differences between the active TENS group when compared to the placebo TENS group for any outcome measures… [1]
quote:A meta-analysis of studies of TENS therapy… found that both TENS and sham TENS significantly reduced pain intensity; no significant differences were found between the two for either analgesic use or pain intensity. These results suggest that, just as with some other interventions, part of the efficacy of TENS can be attributed to a placebo effect. [2,3]
quote:TENS vs. Sham TENS… Fourteen trials were included. None found any difference. [4]
quote:Seven trials compared opioid plus TENS with opioid alone, four of which also included sham TENS. Five of seven trials reported no difference between groups. [4]
quote:They could find no study of note showing any difference in pain intensity or pain relief scores between TENS and a placebo treatment during labor. [5]
In other words, fake TENS - just like fake acupuncture - is just as effective as the real thing.
quote:Almost all the studies are in agreement that TENS does not seem well suited for the treatment of low back pain:
quote:The results of the meta-analysis present no evidence to support the use of TENS in the treatment of chronic low back pain. [1]
quote:For acute back pain, there is no proven benefit. Two small studies produced inconclusive results, with a trend toward improvement with TENS. In chronic back pain, there is conflicting evidence regarding its ability to help relieve pain. One study showed a slight advantage at 1 week for TENS but no difference at 3 months and beyond. Other studies showed no benefit for TENS at any time. There is no known benefit for sciatica. [6]
quote:Transcutaneous electrical nerve stimulation (TENS) has been used to treat a variety of pain conditions… It is generally used in chronic pain conditions and not indicated in the initial management of acute low back pain. [7]
A BIBLIOGRAPHY
1. Milne S, Welch V, and others, Transcutaneous electrical nerve stimulation (TENS) for chronic low-back pain. The Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD003008. http://www.cochrane.org/cochrane/revabstr/ab003008.htm
2. Avellanosa AM, West CR. Experience with transcutaneous electrical nerve stimulation for relief of intractable pain in cancer patients. J Med 1982; 13(3):203-13.
Your chiropractor gave you a massage, some perhaps useful exercises, and an episode with Willy Wonka's Electrocutudinal Zappy Happy-Fun Placebo machine. Of the three, we know which part was guaranteed placebo.
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Wow. Is there anything in the whole wide world that you don't know?!?
Really. It isn't this particular thing that irks me. It is the attitude that there is nothing out there that could be different from what you think it is. That you think that you have the answer to everything and that any experience that might be different is discarded.
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People being knowledgeable about stuff that you don't yet realize shouldn't irk you. If it does, you should spend a good long time wondering about the implications about that.
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There is a difference between being knowledgeable and believing that you know everything there is to know about something.
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quote:Originally posted by kmbboots: That you think that you have the answer to everything and that any experience that might be different is discarded.
Recognizing a moment in which you got pain relief by placebo machine isn't discarding the experience, its recognizing the experience and knowing what actually happened (and why you think what you do about what happened) ... because this is what people are like, and scientific study can show us the many ways we trick ourselves. Or your doctor tricks you.
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quote:Originally posted by kmbboots: There is a difference between being knowledgeable and believing that you know everything there is to know about something.
I can look at the situation and I can realize that there's two potential instances at play; that either you have very mysterious sciatica that is completely unlike any other sciatica in all of recorded and methodologically vetted medical history in the sense that it, alone, can be said to have been actually fixed in a non-placebo way via the application of a TENS unit (as part of a medical practice that is sincerely and demonstrably wrong about the cause of disease, no less), or the use of a TENS unit on your back produced, unsurprisingly, an expected placebo response that you thereupon assumed to be because of something that the TENS unit did that was not placebo. Something which is common, because people respond to placebo and become convinced that something else has happened.
Being knowledgeable enough to know, beyond a vanishingly small sliver of possibility, which of the two is the case here, is different than 'believing I know everything there is to know' about something; be it either a TENS unit or your history of suggestible reasoning patterns which make you an excellent candidate for placebo treatment in the first place.
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So, Samprimpary...I wonder how effective placebos would be for you. Have you ever tried a treatment you would consider a placebo effect? What was the experience like? I'm curious to find out whether placebo effect is only useful for people who want to believe in it. I'm really curious to learn if this effect can be harnessed and used (I think some people do this, at least some of the time, through their religious/spiritual practices). And I'd like to know why chronic pain (such as backaches and migraines) seems to be the sort of thing people are pleased to see placebo practitioners about, and why they prefer it to traditional Western doctoring.
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And really curious about response to placebo as an adaptation in the human population. Is it evolutionarily successful? Is it more or less successful than a reasoning mind that doesn't respond well to placebo effects? Which is better on an individual level? A population level? Why?
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I don't think the evidence on TENS units is quite as one-sided as you make it out to be. I think that there are things about the human body that we don't completely understand yet.
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quote:Originally posted by kmbboots: I don't think the evidence on TENS units is quite as one-sided as you make it out to be.
Well, and this is just idle wondering here, have you read even a single medical article showing any demonstrated effect via a TENS unit on sciatica, versus the numerous medical articles showing that you can give people treatment with a fake TENS unit and they respond as well — if not better — in terms of pain relief as when an actual TENS unit is used in treatment?
Secondly — and this is the more important question — in the absence of having that presentable, vetted knowledge that could show me, actively, some controversy over the effectiveness of TENS units on sciatica in response to me saying 'it's placebo,' what does that say about your endeavor to want to believe that you didn't experience pain relief via placebo!
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Goodness, even Wiki says it is controversial.
I don't "want" to believe anything in particular. I have never been back to a chiropractor - and it has been almost 20 years. I have no stake at all in TENS units.
What bugs me is the arrogance with which you (not just you) seem to think that you know all they answers. You don't. Even grown up scientists are still finding out things.
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quote:Originally posted by kmbboots: I don't think the evidence on TENS units is quite as one-sided as you make it out to be. I think that there are things about the human body that we don't completely understand yet.
I've heard of the god of the gaps, is this the "doctor of the gaps"? The sad thing of this argument is that people use the same thing in favor of homeopathy and its just as valid there. We can't say that homeopathy doesn't work for sure because we don't know there's not something in the body we don't completely understand yet! Now fit homeopathy or god or a tens machine in the gap!
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quote:Originally posted by kmbboots: I don't think the evidence on TENS units is quite as one-sided as you make it out to be. I think that there are things about the human body that we don't completely understand yet.
You cannot reason from "We are ignorant about the human body" to "My explanation of how this worked is correct". Ignorance cannot protect a hypothesis that has been disproved!
But apart from that, just what is it you are arguing here? What is the assertion you want to protect? You have reported that you had electrical treatment and that your back got better; nobody doubts either fact. What then is it that you are so annoyed at having contradicted? We are not in the realm of religious belief now; are you really emotionally attached to the statement "Electricity is good for sciatica"? Because if so, boy, that's a weird thing to get emotional about.
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If you can't tell, I find the entire concept of mind-body connection fascinating. How much do our minds affect our body experiences, and how much do our bodies affect our mental/emotional experiences? That there IS a connection is understood. Beyond that, much is still a mystery!
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quote:What bugs me is the arrogance with which you (not just you) seem to think that you know all they answers. You don't. Even grown up scientists are still finding out things.
Are you seriously saying that the past 50 posts of increasingly bad-tempered discussion arose merely because you were peeved with Samprimary's confident assertion of facts? If so, I would suggest that the fault does not lie in Samprimary.
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quote:Originally posted by kmbboots: Goodness, even Wiki says it is controversial
Not for sciatica. Or is this "controversial" in the same way the earth being more than a few thousand years old is "controversial"? There is controversy, and it is I guess arrogant in the same way on geologists part...
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And why bother to continue arguing? I have lots of questions no one has bothered to discuss, instead people are fighting over a few people's personal perspectives. I was excited for a bit, but now the conversation is getting dull, antagonistic, and not something I feel like participating in any longer.
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Jenny, for what it's worth, I'm very interested in those questions -- but I don't think anyone has anything resembling a real answer to any of them, and don't really have anything novel or earth-shattering to suggest in lieu of actual research.
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I do. But I don't have a computer yet. And am kind of drunk and on a vacation of hedonistic excess. So, later.
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But I totally saw the question jenny and want to respond and dear lord how do you forum on a cellphone without your fingers falling off
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Jenny, they are significant questions. Like Tom, I just don't know any answers or have any intelligent insight. Posts: 14428 | Registered: Aug 2001
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Sammich, stop drunkenly foruming and get back to enjoying your hedonistic chocolate mousse cake and your almost white Russian.
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Jenny, the issue surrounding placebos is that their comforting power is built upon deception. Homeopathy is not based on any reputable science (or logic). Its claims are not founded on any measure of reality. But people feel better because they believe in its power to heal, regardless of any physical improvement. The question now becomes whether to advise a treatment that could potentially make someone feel better even though it is not a true cure WITH the reality that the patient is deceived through the entire course of the treatment.
Is that ethical?
There is no such thing as believing in the placebo effect because by definition the placebo effect requires deception, i.e. believing that a treatment is effective without accepting the reality that it is inert. Why does it work? I can't truly say, but it's been speculated that feeling cared for can significantly improve one's health.
quote:So, Samprimpary...I wonder how effective placebos would be for you. Have you ever tried a treatment you would consider a placebo effect? What was the experience like?
To answer, sort of in order:
I've never really gotten a big effect out of placebo (nor was I ever commonly exposed to 'traditional' or 'herbal' remedy that would have offered me a consistent chance), but there were at least a couple of times where I would have sworn that something worked due to post-hoc reasoning. One of the big ones that works on a lot of people is when they take a bunch of vitamin C when they have a cold and they swear that it helped them get over the cold much much faster; I've done that lots of times. To the extent that I was surprised to learn that it was the product of well-disseminated misinformation by Linus Pauling that anyone thought that vitamin C helped people with colds. It's actually similar to how people thought that carrots improved your vision significantly due to deliberate misinformation by the British government. The ideas have stickiness, so they become new placebos.
The other common ones, such as echinacea, I didn't really go for. I had a perfect opportunity I recall to have been placebo'd by one of my friends; before I knew what homeopathy was, I was offered a homeopathic remedy as a sleep aid by her mother (a registered homeopath), and took the pills every day and went back in a week and said that I was pretty positive they were not having any effect at all. She asked me "You aren't touching the pills, are you? That disturbs their ability to work." That made me very, very skeptical, I later found out under what premise the pills I was taking were supposed to work, and stopped taking them.
quote:I'm curious to find out whether placebo effect is only useful for people who want to believe in it.
You can't 'believe in placebo' in that way. Placebo is getting benefit from the mistaken assumption that you have taken an efficacious treatment for a malady or disorder; it's solidly reliant on deception. For this reason, it's useful for any situation for which people would respond to placebo, whether or not they 'want to believe in it.' It works on people who have been tricked into believing that it is working/has worked.
quote:I'm really curious to learn if this effect can be harnessed and used (I think some people do this, at least some of the time, through their religious/spiritual practices).
It has been and is harnessed, whether the practitioners know it or not. In most cases, it's 'honest placebo,' in the sense that the practitioner believes it to be effective as much as the patient does. In some cases, it's purposeful trickery. As was mentioned before, doctors will prescribe you placebo. My doctor admits to doing it and has stated that over time you learn to spot the people who have suggestible or placebo-prone personalities — the sort to which the current argument (such as it is) acts as a microcosm of the thinking patterns at work; the evidence in the medical field, the understanding about whether or not something is or is not solely a placebo, is manifestly unimportant to them as long as you can give them an opportunity to 'find out for themselves' that it 'worked for them.'
quote:And I'd like to know why chronic pain (such as backaches and migraines) seems to be the sort of thing people are pleased to see placebo practitioners about, and why they prefer it to traditional Western doctoring.
They're excellent candidates for (intentionally or nonintentionally) doctoring via placebo. Things like headaches and back problems are common to the human condition, are often tricky to treat, have a long history of being counterproductively managed by the medical industry (to the point where noneffectual treatment is an alleviation of actively harmful treatment), and are chronic or intermittent human pain responses that tend to respond excellently to placebo in people. To add to that, most placebo treatment for backs is accompanied by massages and personal treatment that tend to 'gin up' a person's susceptibility to placebo; a massage, an adjustment, or a mild electrical stimulation can provide a sensation break or short-term pain alleviation and relaxation which start the positive response to placebo. It doesn't matter what the underlying theory is pretending to treat. You could be 'freeing up vertebral subluxations' or 'chasing out evil spirits.'
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quote:Originally posted by kmbboots: Goodness, even Wiki says it is controversial.
This is not really an answer to my question, but I can extrapolate from it that no, probably not? That you hadn't looked at anything that countered the sources and analysis that I had provided?
quote:I don't "want" to believe anything in particular.
I think it's pretty likely you don't want to believe that you serve as an example of someone experiencing a placebo and turning that into anecdotal vetting for the efficacy of certain treatments.
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I was fed ecenacea with an eyedropper every time I got sick. Hourly. It tasted disgusting. My mom still gets mad at me when I insist it is not a cold or flu remedy.
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For what it's worth, the NIH has a resource for summarizing the scientific evidence for many nontraditional methods of treatment; e.g., Echinacea.
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The NCCAM (National Center for Complementary and Alternative Medicine) is far from perfect, but it is a great resource for figuring out where to go next, if you want further reading, or just for a summary. I haven't been disappointed in what I have found there.
I don't tend to weigh in on Echinacea specifically much these days, because I used to share office space with Bruce Barrett, the MD/PhD who first-authored the first study listed in the NCCAM article I linked above. He is so solid and thorough, and he approached it with such a balanced expectation of what he might find -- and did a randomized, double-blinded, placebo-controlled trial -- that I haven't the ability to look at the situation in an unbiased way anymore. I don't have the appropriate distance any longer.
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I'm a big fan of evidence-based medicine. I'd prefer I not be knowingly treated via the placebo effect.
If I want my mind to make my discomfort go away, I prefer to do it knowingly. I think self-hypnosis is great; been doing it most of my life for various things but am just now learning how much power it really has. I think it should be much more widely taught and used.
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I'd be curious to hear what Samprimary has to say about pinched nerves due to herniated disks, and how they do/don't respond to chiropractic adjustment.
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The answer has been covered, yeah. Here's the wider story.
One: The pinched nerves usually aren't. Instead of saying 'subluxation' or 'vertebral subluxation,' most chiropractors will say they have found a 'pinched nerve,' which is a different way of describing the definition of a subluxation.
Chiropractic conceptualization of nerve impediment via subluxation is completely made up, so a chiropractic diagnosis of nerve impediment, especially spinal, means nothing. This is not an ambiguous fact; vertebral subluxation theory has been debunked so completely that at this point when a chiropractor tells you, absent an actually severe spinal impingement that could have you hospitalized, that you have a 'pinched nerve,' you might as well have a Reiki practitioner tell you you have impeded Chakras. It has nothing to do with actual instances of real nerve impingement.
Two: When you have an actually pinched nerve in an actually verifiable situation where there is nerve impingement, like a herniated disk, don't let a chiropractor near it. Do not go to a chiropractor. Period. Listen to a qualified orthopedist, and (if necessary) a neurosurgeon.
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In cases of pain, a triggered placebo effect can actually work significantly better than actual treatment. I don't doubt that going to a chiropractor relieves pain, but I suspect that if a fake chiropractor did fake adjustments and did fake electrical stimuli, you'd get similar results.
The placebo effect is crazy. I wish I didn't know as much about these things, since now I doubt I'd get the same effect for my own back pain.
I've been thinking about this study for the past few days. If the placebo is twice as effective as actual treatment, I'm not sure it's really dishonest to recommend it. If I was in pain, I would want a doctor to advise me of the best known way to alleviate that pain.
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Yeah, that's the thing about that story, there's two major things to take from it:
1) Acupuncture as an art/science is a sham. There's nothing special about the places they put the needles and fake treatment gets largely the same results.
2) Acupuncture is considerably more effective than traditional treatment!
Reconciling the two is pretty tough to do. As a regular sufferer of back pain, I honestly don't know what to do about it. Do I try the traditional physical therapy route, knowing that it's less effective than a placebo? Or do I try one of the popular placebo treatments (acupuncture, chiropractic), knowing I am being scammed?
Right now I am just doing nothing about it.
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Thanks, Samprimary! I am always intrigued to learn more about people's personal experiences and their thoughts about them.
Tom and Belle, that's why I ask them. Maybe if we keep asking questions, we'll find new answers and new aspects to explore. And maybe we'll end up questioning ourselves and our assumptions, and find out things about ourselves as individuals and a society, too.
I'm finding that I'm rather fond of my placebos, even if that's all they are. They seem to work for me and I find that I am content not knowing exactly why.
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quote:Originally posted by Raymond Arnold: I don't think it works if you know you are being scammed.
The placebo effect can work even if you are aware that it's a placebo though the effect is weaker and less consistent.
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quote:Originally posted by Xavier: As a regular sufferer of back pain, I honestly don't know what to do about it. Do I try the traditional physical therapy route, knowing that it's less effective than a placebo? Or do I try one of the popular placebo treatments (acupuncture, chiropractic), knowing I am being scammed?
Right now I am just doing nothing about it.
I'm fine with placebos when they're applied/prescribed by people who know that it is a placebo (as opposed to thinking it's genuine), because they know both (1) the limitations of the placebo and the appropriate situations for its use, and (2) are vastly better suited to knowing what non-placebo treatments are going to be worth trying, and when to move between them or away from what they know to be placebo.
A better option overall, if your back pain can be effectively managed, is to use treatments that surpass the effectiveness of placebo in double-blind trials. You get the placebo effect from that too, because you know you're trying something which science has shown to work, and the confidence you get out of that is amazing for placebo benefit.
There's plenty of stuff which has demonstrated effectiveness in treatment of chronic low back pain, chief among them well-designed exercise regimens and posture correction. Then there's other stuff which is beneficial to back pain as well as to overall health (obv stuff like weight loss, etc). Simply isolate and remove things which have no scientifically vetted effectiveness.
quote:One: The pinched nerves usually aren't. Instead of saying 'subluxation' or 'vertebral subluxation,' most chiropractors will say they have found a 'pinched nerve,' which is a different way of describing the definition of a subluxation.
Hmm. My chiropractor didn't say he "found" a pinched nerve, he told me that without an MRI we couldn't know what was happening in my back. He suggested a board certified neurologist who could request authorization for said MRI, and when it came back, he looked at it and said: "That thing's gotta come out." So did the neurologist, the radiologist, my general practitioner, and two neurosurgeons.
In the meantime the chiropractor adjusted my back, and gave me relief. You'll have to forgive me, but given that a cough, a sneeze, or a small change in posture could trigger an intense burst of pain, I'm not willing to dismiss the idea that a mechanical movement that repeatably allows me to walk where a moment earlier I was not able to, is a legitimate form of treatment.
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I had a disk problem some years ago that was similarly bad, though not quite as bad as to require surgery, thank god. For me personally, I wouldn't have let a chiropractor within a ten mile radius of my back, it hurt so bad. I couldn't imagine at the time anything done to my back physically being helpful. My physical therapist also left it completely alone, though she did help me with my posture to minimize my discomfort as I recovered, and she did do the electrical stimulation thing, which seemed to help a little as a recall (though briefly).
But really, when a disk is so badly herniated that bumping the toe of your shoe against a door jamb causes your entire left leg to go numb, who wants to submit to the hands of a professional certified in a snake oil science? And the prospect of somebody actually kneading that area with their hands, when it hurt me even to have a pair of pants on that weren't sweats? It wasn't for me.
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quote:One: The pinched nerves usually aren't. Instead of saying 'subluxation' or 'vertebral subluxation,' most chiropractors will say they have found a 'pinched nerve,' which is a different way of describing the definition of a subluxation.
Hmm. My chiropractor didn't say he "found" a pinched nerve, he told me that without an MRI we couldn't know what was happening in my back. He suggested a board certified neurologist who could request authorization for said MRI, and when it came back, he looked at it and said: "That thing's gotta come out."
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