PLACEBO EFFECT
Thousands of articles have been written on this topic, but this more recent
one by the author of the book, “The Relaxation Response” and “Beyond the
Relaxation Response” offers another viewpoint.
Benson H & Friedman R Harnessing the power of the placebo effect and
renaming it “remembered wellness” Annu Rev Med 1996;47:193-9
The placebo effect yields beneficial clinical results in 60-90% of diseases
that include angina pectoris, bronchial asthma, herpes simplex, and duodenal
ulcer. Three components bring forth the placebo effect: (a) positive beliefs
and expectations on the part of the patient; (b) positive beliefs and
expectations on the part of the physician or health care professional; and
(c) a good relationship between the two parties.
Because of the heavily negative connotations of the very words “placebo
effect, ” the term should be replaced by “remembered wellness.” Remembered
wellness has been one of medicine’s most potent assets and it should not be
belittled or ridiculed. Unlike most other treatments, it is safe and
inexpensive and has withstood the test of time.
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NERVOUS SYSTEM – ENTERIC NERVOUS SYSTEM LINKS
Recently there has been a great increase in the amount of research being done
on the digestive system as a neural system in its own right, thereby
suggesting that the old sayings “gut feel” and “I feel sick to the pit of my
stomach” have some scientific basis, after all.
Dr Gershon, a pioneer researcher in this field of neurogastroenterology,
discovered that more than 95% of the body’s serotonin is concentrated
in the gut, so he concluded that serotonin was an additional transmitter in
the GI system. This makes one wonder if Prozac and related serotonin
interactive drugs are acting predominantly through the gut or through the
brain. Gerson added that neurotransmitters, growth factors, and many
peptides known in the brain are also found in the gut, suggesting that there
is “a little brain in the gut.”
Another researcher in this field, Dr Camilleri, remarked that “The enteric
nervous system is to a large extent independent, and it is only fine-tuned by
extrinsic nerves that connect it to the brain for motor functions. Like the
more familiar central nervous system (brain and spinal cord) and peripheral
nervous system (nervous tissue outside the brain and spinal cord), the
enteric system includes vast networks of neurons; their supportive glial
cells; and messenger molecules, such as neurotransmitters, neuropeptides, and
growth factors.
It is interesting that some of the earliest research into the enteric nervous
system was conducted by none other than the Russian physiologist, Ivan
Pavlov, who noted in the late 1800s that stimulating a dog’s mouth causes its
stomach to secrete digestive acid. It seems as if he was an unsung pioneer
in quite few important fields!
Here is another article in this field:
Furness JB, Kunze W & Clerc N Nutrient tasting and signaling mechanisms in
the gut. II. The intestine as a sensory organ: neural, endocrine, and immune
responses. Am J Physiol 1999 Nov; 2 77(5 Pt 1): G922-8
The lining of the gastrointestinal (GI) tract is the largest vulnerable
surface that faces the external environment. Just as the other large external
surface, the skin, is regarded as a sensory organ, so should the intestinal
mucosa. In fact, the mucosa has three types of detectors: neurons, endocrine
cells, and immune cells. The mucosa is in immediate contact with the
intestinal contents so that nutrients can be efficiently absorbed, and, at
the same time, it protects against the intrusion of harmful entities, such as
toxins and bacteria, that may enter the digestive system with food. Signals
are sent locally to control motility, secretion, tissue defense, and vascular
perfusion; to other digestive organs, for example, to the stomach,
gallbladder, and pancreas; and to the central nervous system, for example to
influence feeding behavior.
The three detecting systems in the intestine are more extensive than those of
any other organ: the enteric nervous system contains on the order of 10(8)
neurons, the gastroenteropancreatic endocrine system uses more than 20
identified hormones, and the gut immune system has 70- 80% of the body’s
immune cells. The GI tract has an integrated response to changes in its
luminal contents. When this response is maladjusted or is overwhelmed, the
consequences can be severe, as in cholera intoxication, or debilitating, as
in irritable bowel syndrome.
Thus it is essential to obtain a full understanding of the sensory functions
of the intestine, of how the body reacts to the information, and of how
neural, hormonal, and immune signals interact.
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So what does all this have to do with Back Injury and the Mind?
Well, it means that while there may be definite anatomical and physical
causes of back pain (such as a mechanical fractured bone, herniated disc or
damaged nerves), there may also be mental factors that can cause, worsen or
decrease back pain. However, it would be foolhardy to state that ALL back
problems are the result of an “unhealthy” or unholistic state of mind – try
telling that to all the paraplegics and quadriplegics out there!
Equally well, it is foolhardy to believe anyone who maintain that faulty
posture is the leading cause of back pain and dysfunction, for there is more
than adequate research to show that such a correlation is tenuous at best.
Clinicians and researchers have noted that a significant number of patients
have severe back pain without showing any clear mechanical or physiological
causes – or “poor” posture, for that matter. It is largely this group that
Dr Sarno addresses in his work. Thus, it is important to use modern medical
technological means to make a more accurate diagnosis and to proceed from
that point.
Dr Mel C Siff