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A patient’s belief that a drug will not work can become a self fulfilling prophecy, according to researchers.

They showed the benefits of painkillers could be boosted or completely wiped out by manipulating expectations.

The study, published in Science Translational Medicine, also identifies the regions of the brain which are affected.

Negative thoughts rendered painkillers ineffective

Experts said this could have important consequences for patient care and for testing new drugs.

Heat was applied to the legs of 22 patients, who were asked to report the level of pain on a scale of one to 100. They were also attached to an intravenous drip so drugs could be administered secretly.

The initial average pain rating was 66. Patients were then given a potent painkiller, remifentanil, without their knowledge and the pain score went down to 55.

They were then told they were being given a painkiller and the score went down to 39.

Then, without changing the dose, the patients were then told the painkiller had been withdrawn and to expect pain, and the score went up to 64.

So even though the patients were being given remifentanil, they were reporting the same level of pain as when they were getting no drugs at all.

Professor Irene Tracey, from Oxford University, told the BBC: “It’s phenomenal, it’s really cool. It’s one of the best analgesics we have and the brain’s influence can either vastly increase its effect, or completely remove it.”

The study was conducted on healthy people who were subjected to pain for a short period of time. She said people with chronic conditions who had unsuccessfully tried many drugs for many years would have built up a much greater negative experience, which could impact on their future healthcare.

Professor Tracey said: “Doctors need more time for consultation and to investigate the cognitive side of illness, the focus is on physiology not the mind, which can be a real roadblock to treatment.”

Brain scans during the experiment also showed which regions of the brain were affected.

The expectation of positive treatment was associated with activity in the cingulo-frontal and subcortical brain areas while the negative expectation led to increased activity in the hippocampus and the medial frontal cortex.

Researchers also say the study raises concerns about clinical trials used to determine the effectiveness of drugs.

George Lewith, professor of health research at the University of Southampton, said: “It’s another piece of evidence that we get what we expect in life.

“It completely blows cold randomised clinical trials, which don’t take into account expectation.”

By James Gallagher

Health reporter, BBC News

The skin gun is no longer science fiction. A doctor has created a prototype medical device that literally sprays skin cells onto burn victims to re-grow skin.

Once grafts took weeks, but now the skin gun does the work in under two hours and the burns heal within days. It has successfully treated over a dozen patients so far.

Doctor Jörg Gerlach, of the University of Pittsburgh’s McGowan Institute for Regenerative Medicine, has discovered a method which regenerates healthy skin stem cells from the victim and sprays it on the burned skin.

Instead of a deep sleep, general anesthesia is more like a reversible drug-induced coma, U.S. researchers said on Wednesday, in findings that could lead to better treatments for coma and better anesthesia.

“General anesthesia is pharmacological coma, not sleep,” said Dr. Nicholas Schiff of Weill Cornell Medical College in New York, who worked on the study with Dr. Emery Brown of Massachusetts General Hospital and Dr. Ralph Lydic of the University of Michigan.

Their findings, published in the New England Journal of Medicine, represent a three-year exploration of the similarities and differences of sleep, anesthesia and coma.

They said while doctors and patients commonly describe general anesthesia as going to sleep, there are significant differences between the states, with only a bit of overlap between the deepest states of sleep and the very lightest phases of anesthesia.

While sleeping usually involves moving through a series of phases, in general anesthesia, patients are typically taken to a specific phase or state and kept there during the surgery. This phase most closely resembles a coma.

“The brain is becoming very, very quiet. The activity of the neurons is being dampened dramatically,” Schiff said in a telephone interview. “That is also true in coma.”

Schiff, an expert in coma recovery, said while no two brain injuries are alike, studying the way people come out of anesthesia could be used as a model for predicting the stages of emerging from a coma.

“Although recovery from anesthesia is much faster, there are hints that some of the circuit mechanisms have some overlap,” he said.

That could lead to monitoring tools and diagnostics to assess what stage of recovery a person with a coma is in, and it could be used to develop new strategies to help doctors bring patients back to consciousness.

Knowing more about the brain circuit mechanisms may also help researchers develop drugs to tweak specific brain circuits, Schiff said.

And the study should lend new insight into understanding general anesthesia, Brown, an expert in general anesthesia, said in a statement.

“Anesthesiologists know how to safely maintain their patients in the states of general anesthesia, but most are not familiar with the neural circuit mechanisms that allow them to carry out their life-sustaining work,” he said.

www.newsdaily.com