A regular blog reader shared this interesting research review on the placebo effect and genetics.
It turns out that researchers (in the pharmacology world) have found what they call the placebome (placebo genome) that can predict whether someone would be have a stronger placebo effect.
We WANT these types of patients with the placebome in our practices, they're are most likely more easily influenced, have a positive expectation of benefit from the visit/interaction. You are having placeo/nocebo effect, intentionally or not. My former business partner could charm anyone, and has been heard to say to an anxious patient who was telling him how bad their back felt, "Aw, that's easy, we have just the thing for that."
In terms of genetics, it makes sense clinically; we have all come across patients with what I would call a certain "disposition" that just will not buy into anything you have to say. You can start Pain Science and that is "all in my head?" and then go old school pathoanatomy and you get "I don't think PT works..." etc. These Debbie Downers are slow (or no) responders, at least initially. Perhaps they need a kick in the rear that you cannot give.
In the past, I would have just thought they required multiple visits and were slower to respond, but unless I can make that therapeutic alliance with them in 2-3 visits, I refer them on, perhaps to a psychologist or pain management - whatever it is they think may help them.
When I refer out, it is normally with the intention of following up with the patient after they see the other practitoner, sometimes they come back when they got the clear x-ray, bloodwork, or some meds/shot, sometimes they don't. These cases do not get any less frustrating the longer I am in practice, as we tend to want to help everyone, but it's interesting how it may be everything from stubborn neurotags, to genetics, to life experiences, and most likely some combination of all of the above.
Just rambling, and this did not come out as coherent as I thought, but still, I like to
Keep it Eclectic....