I am not denying the importance of the placebo effect (which does indeed have a physiological mechanism currently under investigation) I am just emphasizing that it is time we strive for something more effective.

Many texts have been written examining the mechanism and amplitude of the placebo effect. One consistent finding is that the strength of a placebo is intimately related to the degree of patient expectation. In turn expectation is closely related to invasiveness. That is to say certain placebo therapies may be more effective than others because they are invasive, therefore, the patient identifies this with a high expectation that the treatment will have a therapeutic effect. For example acupuncture, saline injections and sugar pills are all forms of therapy with a high level of perceived invasiveness and therefore result in high expectations that the treatment will be beneficial (in turn stimulating the mind-body connection, i.e. placebo effect). Now, this is still an unsubstantiated theory but it does have interesting implications. For example, why perform true acupuncture (following meridians) when sham acupuncture (random application) is often equally effective. The placebo effect can be produced by any form of treatment as long as the client can be persuaded that the treatment may have an effect (i.e. as long as a positive expectation can be formed).

I think there is two ways of looking at this issue: (1) from the perspective of a health care professional with the duty of beneficence and (2) at the level of policy. In (1), a physiotherapist should act in the best interest of each and every patient to ease their pain, facilitate healing, and improve function. On the other hand, at the level of policy management, the whole population is considered and not just the individual. Perhaps, it could be concluded that resources are being squandered by supporting a placebo therapy rather than allocating resources to R&D to discover novel, more effective (above and beyond placebo) forms of treatment.

Furthermore, it is my opinion that one must consider the veracity of using a modality with little to no best research evidence supports its use (e.g. most electrophysical agents). Reminds me a little of selling snake oil.

The main problem with electrophysical agents is that although they may reduce subjective pain responses, they rarely if ever improve function. This is the primary reason that most worker compensation boards vehemently disaprove of their use - they don't facilitate return to work.

I'm sorry if I come across skeptical or close minded. My true intention is to stimulate discussion.