In the 1970s it was still acceptable to give placebo medication to patients without their knowledge. The physician would write an order for an inert pill for pain or other symptoms and staff would whisper to each other when the “medication” was given. Placebos are rarely ordered now and can only be given with consent by the patient which undermines the theoretical effectiveness of belief. Belief is strong medicine and there is physiological evidence that placebo treatment does work.
Home care therapists were assigned a portable ultrasound machine for treatment of soft tissue inflammation and pain. Each treatment is about 5 minutes in duration and sometimes there is slight warmth emitted from the head of the machine. Generally there is no sensation except for pressure on skin as the therapist applies the gel and applicator in a circular fashion. I personally have never observed any value in ultrasound treatments, on myself or any patient, and it is hard to do a clinical study to prove its efficacy.
I had a referral to give an ultrasound treatment to a lady who had received them in the past. She was sure this was the answer to her back pain and I took the portable unit into her older home. To my dismay all the electrical outlets were ungrounded and I could not plug the machine's three pronged cord anywhere in the house. I made a completely unethical decision, pretended to plug in the machine, and went on to give her a “massage” with the ultrasound head. She insisted that the treatment was wonderful and her pain was much improved.
Another old lady had a very stiff neck with crepitus and pain with the slightest movement. I gave ultrasound treatments, massage, and mobilizations over the course of a month with absolutely no improvement. One day I returned for another visit. Her pain was completely gone and she had full range of movement. A friend had given her garlic cloves that had been soaked in cider vinegar for a month and she was eating one each day. I rejoiced with her and was very relieved to be done with that cervical spine! Was the garlic and vinegar a cure or a placebo? I suspect it was a bit of both but it was undoubtedly more effective in treating inflammation than anything the doctor or myself had offered.
A physiotherapist often spends a lot of time with a patient and we are practitioners who touch people in the course of treatment. Few doctors physically examine or touch their patients anymore relying instead on test results and prescriptions. A sympathetic, listening ear is a good way to start a patient on the road to healing. I truly believe that compassionate human touch is essential for health and is lacking in the lives of many people.
Most of what I do professionally is validated clinically but I never discount the placebo effect or minimize a positive experience that cannot be explained.