Placebo is an interesting word and concept.  It conjures up trickery or being scammed; thoughts originating from the history of snake oil salesman traveling about in the 19th century.  Placebo is used to help distinguish efficacy of interventions in clinical research and it should be said that the placebo effect cannot be specifically distinguished from an intervention itself. 

Just recently, my family and I were returning home from a jaunt up to grandma's house.  I'm usually the car's driver while my wife and daughter assume the luxurious position of passengers.  I should say sleeping passengers.  It's a curvy road for half the trip (I'll save my thoughts about car sickness for my other blog).  My daughter woke up nearing the end of the curvy part and began to cry.  When it didn't seem like the cry was going to resolve itself I inquired, "What's going on Bubba?"  Yeah, I call her "Bubba" - I find it humorous to have given her an unfitting gendered nickname.  Anyway, she responded, "My neck hurts".  

[NOTE: Usually my first response in most cases like this is: "Ok, you'll be fine" or "Oh, ok.", then waiting for any development to progress.  This is usually closed with: "See… you're fine now." or "This is great, you're all healed up like always."  I do this to make sure both consciously and sub-consciously it continually registers that she always heals and everything turns out fine in the end.  And, the reason I do this is: a) it's true and b) it helps to keep her nervous system from developing a (more) sensitive catastrophizing state as it becomes more mature.]

I then asked, "Can you move your head and neck to a spot where it stops hurting?"  

A few moments later, "No." She continued to sob.  

"Ok, take some deep breaths and relax."  More sobbing.  Now keep in mind, I am still driving on a curvy road as I negotiate a therapeutic relationship.

I start to get more specific with her, "Ok, I want you to touch your chin to your chest and then tell me if it still hurts".

"Yes, it does".

"Ok.  I want you to press the back of your head to the car seat and then tell me if it still hurts".

"No, it doesn't".

"Ok."  Now, that we have found a position that relieves the pain my goal is to then guide her in creating movement expression from this "safe" place.  It's safe because the central nervous system has deemed it to be so by stopping it's creation of a pain signal.

"Now, I want you to imagine your nose is a paint brush."  She loves to paint.  So, to me, this adds to the safe environment by adding enjoyable imagery.

I continue, "Keep your head pressed lightly against the car seat and imagine painting slightly to the left and slightly to the right.  Tell me if it hurts when you do this."

"No, it doesn't".

"Ok. Paint a little more to the left and and a little more to the right.  Still ok?"

"Yes."

"Now still keeping your head pressed lightly against the car seat, imagine painting slightly up and slightly down.  Still ok?"

"Yes."

"Ok.  Paint a little more up and a little more down.  Still ok?"

"Yes."

"You are doing real well here.  Now I want you to imagine slowly painting a small circle in front of you.  Still ok?"

"Yes."

"Do the same thing again, but paint the circle in the other direction.  Still ok?"

"Yes."

"Ok.  Paint a slightly larger circle and tell me how that feels?"

"Daddy?"

"Yes?"

"Can we be done now?"

"Why"

"My neck doesn't hurt any more."

"Really?  You can move any way you want?"

"Yes."

"That's fantastic!  You did it!  You're all better now!!"

Like I said above, the placebo effect cannot be specifically distinguished from an intervention.  Was it the intervention (plus placebo) or was the pain going to pass on it's own?  I think building a context for resolution and assisting with ideas for possible ways to move may have sped up the positive outcome, but I will never know for sure.  The sub-conscious brain has powerful self-normalizing controls.  If it can be convinced that a threat to it's tissues has passed, there will be resolution.

My daughter is 7 years old.  I'm hoping that in time - with experiences like this one - she realizes that her body heals quickly and… that she can explore her own movement to help lift the perceived threat to her nervous system (experienced as pain in this case).  To me, this is the ultimate placebo effect.