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kbrown's picture

Top down pain alteration

Hi everyone,

   I thought our discussion of pain measurement and pain processes were really interesting on Tuesday.  One thing that really caught my attention, like it seems to have caught some others in posts before this one, is our discussion on acupuncture as a possible means of pain treatment.  I thought this was particularly interesting in leu of our discussion the week previous about phantom pain and the placebo affect.  When discussing the results of acupuncture, and whether we can actually take any effectiveness as truly an effect of the treatment or a purely a placebo affect, I brought up the fact that my dog has had successful results from acupuncture treatment for hip dyslpasia as support for the opinion that acupuncture does treat pain through processes other than that of the placebo effect.  My thought process was that because presumably dogs, cats and other types of domestic animals are unaware that they are being treated, they do not have any expectations to get better, and therefore any effect of this type of alternative treatment is most likely due to the treatment itself.  However, I realized later that there are other factors that could be effecting alternative treatment on these animals.  For instance, it is possible that the stress involved in such treatment, or simply involved in a visit to the vet, could be triggoring a type of stress induced analgesia which may mimick a true effect of the treatment. 

Also in more broad terms, another question came to me when we were discussing top down processes for pain inhibition and intensification.  The types of psychological and social variables which qualify for this category seem to be things like catastrophizing and stress, however, I was jsut wondering where the placebo effect itself fits in.  My initial reaction is that the placebo effect is not a top down process because in my understanding it does not effectively "close" melzack and wall's pain gate but instead by encouraging the release of endogenous opioids (as Alex A. pointed out in the last discussion).  However, like catastrophizing the placebo effect seems to be based in a psychological state of mind, namely in the expectation of getting better.  So then, is there a qualitative difference between the way the placebo effect works and the way top down processes effect pain, or are they interconnected?

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