COLUMNIST BUSINESS TALK Responding to meaning S Manipulating the clinical environment to maximize outcomes and modulate pain perception resulting in pain relief by positive expectations. For instance, in number one (in-structions), being able to explain to your patient how your treatment works and why it can reduce their pain will pre-dispose them to feeling a positive effect from it. It’s helpful to explain chiropractic treatments in simple, easy to understand terms. For number two, add a change in environment with treatments. For example, when I apply acupuncture I always dim the lights and turn on relaxing music. For num-ber three, social media and patient testimonials online are driving patients clinical expectations. The more they read about how great you are online in social platforms, the more they will expect to feel better. BY ANTHONY LOMBARDI ix years ago I wrote an arti-cle about the importance of something called The Mean-ing Response . This term for decades was called the pla-cebo effect. Jonas ( Frontiers in Psychol-ogy , Aug 2019) says that placebo should be replaced by meaning response – but its all semantics, really. Placebo implies that something without any “medicine” is helping the patient but that very thing without “medicine” ie. the mean-ing -becomes the medicine. Not only is the meaning response real -it is vital for the maintenance of long-term clin-ical success in practice. The research by Moerman (2002), Walach and Jonas (2004), Newman (2009), and others exemplified how therapists use something called the meaning response to harness healing capabilities within their patients during treatments. However, more recently, Solle et al (2016) went deeper to help determine why the meaning response was so effective and long lasting in clinical practice. Several studies on analgesia-related placebo research showed that patients have higher placebo responses in com-parison to healthy participants, which may also last longer. They asserted that expectations played a key role in pla-cebo analgesia. Further, these expecta-tions could be induced via three central psychological mechanisms: 1. Expectation induced via instruc-tions 2. Expectation induced via classical conditioning and 3. Expectation induced via social learning. Simply, these mechanisms are con-trolled by neurobiological structures This neurohumoral reaction sees the release of endorphins flood pleasure centres in the brain. This causes a re-laxation reflex in the arteries of the central and peripheral circulatory sys-tems, which provide oxygen-rich blood to neuromusculoskeletal tissues. Be-cause this is a reflexive response, the patient subconsciously breaks the psychological and physiological cycle of pain – and this makes the body more receptive to the treatment they are about to receive. For example, using a functional as-sessment approach that demonstrates muscle weakness or imbalance is some-thing that lets patients see, feel, com-pare, and understand the difference in their own way. They are likely unable to interpret an EMG or an X-ray, but they can sure tell if the gluteus maxi-What does the meaning mus on the left is weaker than the one response do? on the right. Then using an interven-Meaning response is the brain’s per-tion to restore the muscle strength is a ception of the surrounding environ-tangible result that provides a positive ment, which elicits a physiological re-meaning response to the patient, vali-sponse that decreases sympathetic dating their presence in your office and tone. (A patient walks into the doctor’s offering hope for the future. office and instead of feeling In addition, DC’s should get nervous, they feel relaxed.) If a patient has into the habit of explaining This gives the therapist an a better idea conditions like osteoarthritis, advantage because the sym-regarding how rotator cuff tears and disc pathetic nervous system, the treatment bulges in a way that breaks which is active during pain works, they down these concepts to a level and times of anxiety, be-that an eighth-grade student will have a comes submissive when ac-would understand. If a patient greater tual relaxation occurs in the neurohumoral has a better idea regarding how mind and body. For example, response to the treatment works, they will when a patient with have a greater neurohumoral the post-traumatic stress disor-intervention. response to the intervention der walks into my clinic and (Walach, 2004). is greeted by Nitro, our ten-pound toy Applying therapies in a therapeutic poodle -a physiological transformation setting where the environment mirrors takes place within the patient’s body. a comfortable space, as opposed to in a traditional clinical setting, will ele-ANTHONY LOMBARDI, DC, is a private consultant to athletes in the NFL, CFL and NHL, and founder of the vate the meaning response (Walach Hamilton Back Clinic, a multidisciplinary clinic. He teaches his fundamental EXSTORE Assessment System 2004). In my clinic, the reception area and practice building workshops to various health professionals. For more information, visit www.exstore.ca. is furnished with comfortable couches 10 Canadian Chiropractor December 2019 www.canadianchiropractor.ca
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