The Role of the Brain in Osteoarthritis is Bigger than You Think

Wanted to share two review studies that really show why I target the brain directly when treating chronic conditions- in this case Osteoarthritis. Both articles here are systematic review studies, which pool data from multiple studies to get a better idea of the overall impact of certain treatment effects. What we are looking at in these two reviews is what’s called contextual effects, which are treatment effects (reductions in pain) not produced directly by the treatment itself. Contextual effects are also known as placebo effects, which we know now are actually real effects in the body produced by the brain.

I was interested in seeing how much impact the brain has on overall pain reduction with a common condition like osteoarthritis. I think you might be surprised by the percentage of the treatment effect (pain reduction) that comes from the brain and not from the treatment itself. Have a look at the results below.

This first review study in 2015 looked at 215 trials and 41,392 people with osteoarthritis (OA). They looked pharmacological, non-pharmacological treatment, and surgery for treating OA. Here’s what they found and I will quote the authors: “The majority (75%) of the overall treatment effect in OA RCTs is attributable to contextual effects rather than the specific effect of treatments.” Wow- so 75% of the treatment effect (pain reduction) essentially comes from a change in the brain, not the treatment itself!

In this second review study in 2020 they looked specifically at knee osteoarthritis and five non-pharmacological and no-surgical treatments( acupuncture, exercise, TENS, laser treatment, ultrasound.) . They reviewed 25 studies with over 2000 people. Here’s what they found- authors quote: “Our findings suggest that about 61% and 69% of the total treatment effect experienced by subjects receiving acupuncture and TEM(exercise, TENS, laser treatment, ultrasound) treatments, respectively, for knee OA pain may be explained by contextual effects.”

What these studies tell me is 2 things:

1) We need to move away from thinking the specific body treatment is what causes a change in pain to understanding it is more likely to be the brain that is changing and that itself has the biggest treatment effect.

2) Harness the power of the brain directly to heal.