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You might have seen a news item — just like a nearly identical one in 2010 — about placebos working on back pain even when the patient knows it isn’t real medicine: “placebo without deception” supposedly. Dr. Gorski peels that claim apart like a mandarin orange and devours it in a new article: “The revenge of the son of the myth of ‘placebos without deception’.” In a nutshell…
Is it a non-deceptive placebo if you do it by saying “this fake medicine is really awesome”? Still no. That’s just a regular placebo — very old school. There’s really nothing new here. There wasn’t in 2010, and there isn’t now. It’s not placebo “without deception,” but placebo with deception about the value of placebo itself.
It’s just more hype about the “power” of placebo, and I’ve now updated that article with some analysis of this “news.”
So this is kind of huge. Next year the journal Manual Therapy is changing its name to Musculoskeletal Science & Practice. Here’s their under-stated explanation:
The new title will better reflect current practice, education and research in the field of musculoskeletal physiotherapy worldwide and ensure that the journal continues to be a leading publication in the field
In other words, “manual therapy” is too narrow, too much about fixing people with techniques and magic hands, and neglects other perspectives and approaches. The change signals a general retreat from the belief that flesh and structure need to be changed… or even can be. It’s writing on the wall that says that manual therapy needs to get beyond being “manual.”
A fine rant here from physical therapist Sigurd Mikkelsen about a clinical experience. (And please note: the harsh language is not a transcript of his actual clinical communication, but a frustrated description of how he felt about it.)
Things that piss me off… first consultation today - a young active girl with an ACL injury. Got told by the doctor that she'd never play football again after looking two seconds on her MRI. Instantly scared the shit out of her and all her dreams about sports and becoming a police woman were brutally shattered.
Cried (out of relief) when I said this Doc should go F%&K the H#LL off and told her how Kjetil Jansrud won Olympic Gold in Super-G one year after his ACL-injury. Then went off with a 15 min continuous heroic rant about how fu&king fantastic and adaptable our bodies and minds are and threw around stories about great comebacks and insane human achievements. She felt better when she left the office.
FFS!!! Mind your words!!! They can change lives forever!
I hear stories like this on a daily basis, and I have for my entire career: patients are constantly told depressing, scary, bogus things about their injuries, based on shallow examination and the pernicious belief that we are like fragile machines — as opposed to freakishly resilient biological marvels. My inbox is full of it, like it’s coming from a firehose. And that’s why I get so exasperated when I get “don’t throw the baby out with the bathwater” reactions every time I try to swing the clinical reasoning pendulum away from structuralism and “fragilistic thinking”. The pendulum has never even come close to descending to a balance point between a biomechanical perspective on musculoskeletal medicine versus a neuro/bio one… let alone swinging too far in the other direction.
I regularly get both fan mail and hate mail about “your article” with no identifying details. Which article would that be? The one about Epsom salts? The one about chiropractic? The one about lump in the throat? The one about bogus citations? The one about tennis ball massage? The one about benzos? The one about stretching? The one about fascia? Massage? Trigger point doubts? Posture? Headaches? Waterproof jackets? Resting? Rhabdo? Placebo? Orthotics? Shortness of breath? Insomnia? Worrying? Back pain? My barber? Craniosacral therapy? Frictioning? And about six hundred more.
I give up. 😜
“To deal with their miserable lives” naked mole rats evolved to feel no pain:
And yet in this harsh environment, under extremely crowded conditions, the naked mole rat has evolved to be virtually indestructible: these small mammals almost never get cancer, live to be over 30 (much longer than other rat species), and they are insensitive to acid burns. Now a new study in Cell Reports reveals one secret behind these rats' abilities. Evolutionary tweaks to the amino acids in their pain receptors make naked mole rats extremely insensitive to pain after they are born.
I think it’s surprising and fascinating that immunity to pain isn’t a more common adaptation in biology. Clearly pain has potent survival benefits — the ultimate double-edged sword.