Robert Burton of Salon wrote an interesting piece that discusses both the field of prescription drug marketing and how fMRI brain scans have been used to show that pain is “real.”

Fibromyalgia is a condition in which patients seem to experience more pain than non-sufferers. Fibromylgia is thought to be stimulated by mental states like anxiety and depression, but no specific measures like blood tests, X-rays, autopsies, etc., demonstrate any evidence of the condition. The only thing that physicians have to work with is the subjective descriptions of the patients as to their pain level. Now, fMRI brain scans which show more pain-related brain activation in fibromyalgia sufferers may open the floodgates for pharmaceutical companies to offer products like Lyrica to treat the condition. Of course, what the fMRI is showing is that the patient is experiencing a higher level of pain than normal, not that there is a specific organic reason for the pain.

This whole discussion gets into the fascinating area of expectations and individual experience:

If you think an inert sugar pill (placebo) is a powerful analgesic, taking it can reduce your level of pain from, say, a dental procedure or wear-and-tear arthritis. Conversely, if you are given the same sugar pill and told it is a new untested drug and might make your pain worse, you might experience more pain (nocebo effect). Your imagined expectation of what the pill might do will affect both your pain perception and what changes will be seen on functional brain imaging. Nowhere in this schema is there any suggestion that changes in pain perception arising out of imagination aren’t real. Placebo-induced relief of pain is clinically identical to pain relief from standard analgesics such as morphine.

Now consider one of the central features of fibromyalgia — an increased number of areas sensitive to ordinary pressure. If you believe you have a condition that makes you more sensitive to painful stimuli, you may well experience more pain than those who believe they aren’t sensitive to painful stimuli. This difference in pain appreciation or description, and the attendant brain changes on fMRI, will not reflect any underlying disease; both will be the reflections of your own self-perception. Even such personality traits such as optimism or pessimism (half-empty vs. half-full), or one’s attitudes toward the medical establishment, can make critical differences. [From Salon – Big Pharma says your mysterious pain is real by Robert Burton.]

If a fibromyalgia sufferer experiences higher pain levels than a normal person, does it matter that the pain is a result of a specific organic cause or a cycle of expectations of pain? And should it be treated with expensive drugs, or would a placebo work just as well? Of course, you can’t just hand someone a bottle of cheap pills labeled “Placebo – no active ingredients.” Since the placebo effect is all about expectations, the patient must believe that the drug is, in fact, highly effective.

Last year, I wrote about research that showed that more expensive placebos were more effective pain relievers (see Placebos, Price, and Marketing). Even the color of the pills had an effect on their perceived effectiveness, with black and red pills outperforming white ones. At the time, I suggested that a bigger “buildup” in terms of presentation to the patient might perform even better.

This begs the question: if Lyrica proves to be effective for pain relief in fibromylgia sufferers, will it be because of its organic effects on the patients’ nerves? Or will it in essence be a costly placebo, made even more effective by its price, its brand recognition, and the potency suggested by a lengthy list of side effects?

The neuromarketing lesson in all of this is that we are all influenced by our expectations, and marketers need to set positive expectations for the customer experience and, to the extent possible, avoid negative expectations. When a patient, or customer, really believes something, it can often turn into their reality.

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