The Power of Positive Expectations with Parkinson’s

Parkinson disease symptoms may improve when patients expect treatment to be better

(RxWiki News) The mind can be a powerful healer. If patients believe a medication will work, it may boost their health. And new evidence may support this “placebo effect.”

Parkinson’s patients may see improvement in their symptoms if they simply believe a treatment is more expensive, a new study found.

This study was led by Alberto J. Espay, MD, of the University of Cincinnati in Ohio.

“My interpretation [of the study] is that the actions of medications can go beyond their known [effects] if they are believed to be ‘better’ in some other fashion not directly related to what they are known to do,” Dr. Espay told dailyRx News. “Thus, when doctors imply that a medication ‘helps virtually everyone that takes it,’ they might be applying such a concept and truly harnessing the power of positive expectations above and beyond the positive pharmacologic benefit they are intending to get.”

Dr. Espay was referring to the placebo effect. This effect is a phenomenon in which a patient is given a fake medication. It could be just sugar or a saline (salt) solution. The patient, however, sometimes gets better because he or she believes that treatment is effective.

Dr. Espay and colleagues evaluated the response of 12 patients with Parkinson’s disease to two different placebos. One was supposedly much more expensive than the other.

Patients were told that they would receive two forms of the same medication. These forms were, in fact, nothing more than identical saline solutions.

These researchers told the patients that the treatments were identical, except that one cost $100 per dose while the other cost $1,500 per dose. The patients first received either the “cheap” or the “expensive” treatment. About four hours later, the patients were given the other placebo.

Parkinson's is a nervous system disease marked by tremors and trouble with movement.

Before and after each shot was given, Dr. Espay and team assessed patient motor skills and measured brain activity through brain scans.

Overall, patients' symptoms improved 9 percent more when they received the more expensive treatment first rather than the cheaper treatment.

Dr. Espay and team noted that motor skills improved by 28 percent more when patients received the more expensive treatment first than when they received the cheaper treatment first.

In one test of motor skills, patient scores rose by 7 points when taking the more expensive treatment first, but they only went up by 3 points when taking the cheaper placebo.

The authors of an editorial about this study said dopamine — a brain chemical that is often lacking Parkinson's patients — may play a part in the results of the current study.

“The findings of the current study build on other insights into placebo effect and Parkinson’s Disease, including evidence that regional release of dopamine in the striatum [a region of the brain] may be increased in response to expectation of reward or clinical improvement,” wrote Peter A. LeWitt, MD, director of the Parkinson’s Disease and Movement Disorders Program at Henry Ford Hospital in West Bloomfield, MI, and Scott Kim, MD, of the Department of Bioethics at the National Institutes of Health.

After Dr. Espay and team completed their research, they told patients about the true nature of the treatments. Eight patients said they did have greater expectations from the more expensive treatment. On the other hand, four patients said they had no expectation of greater benefits from the more expensive treatment. Those same patients showed few overall improvements in the study.

This study was published online Jan. 28 in the journal Neurology.

The Davis Phinney Foundation for Parkinson’s Disease funded this research. A grant from the National Institutes of Health funded Dr. Espay. Dr. Espay also received support from CleveMed/Great Lakes NeuroTech, the Davis Phinney Foundation and the Michael J. Fox Foundation, as well as funding from Solvay, Abbott, Merz, Chelsea Therapeutics, Teva, Impax and Eli Lilly.

Review Date: 
January 28, 2015
Last Updated:
January 29, 2015