Abstract
A burgeoning body of evidence supports the efficacy and elucidates the mechanisms
of placebo analgesia. Debate persists, however, concerning their ethical use, with
many of the present arguments being philosophically based. The present web-based study
empirically investigated the acceptability of an analgesic placebo treatment. Participants
(103) responded to vignettes depicting patients receiving a placebo analgesic. We
experimentally manipulated: 1) placebo treatment instructions (level of deception);
2) treatment outcome; and 3) patients’ pain severity. Participants rated vignettes
on outcome measures of deception, physician-patient relationship, and patient mood.
Participants then characterized a range of placebo acceptability through ratings of
deceptiveness, effectiveness, and negative consequences. Results showed that placebos
described as “medication shown to be a powerful analgesic in some people” were equally
deceptive as those described as “standard drug treatment.” Ratings of patient mood
and physician approval were determined as much by treatment instruction as by treatment
outcome and an analgesic response mitigated the negative consequences of deceptive
administration. Participants tolerated moderate effectiveness and considerable negative
consequences in an acceptable placebo, although results suggest lay individuals may
not have a sophisticated conceptualization of placebo effectiveness. Studies altering
individuals’ understanding of placebo effectiveness and mechanisms are needed to identify
additional factors determining placebo acceptability.
Perspective
This study represents an empirical examination of analgesic placebo acceptability
among lay individuals. This article is the first to systematically manipulate deception,
treatment outcome, and disease severity to determine how these factors interact to
differentially determine placebo acceptability—a highly relevant finding that informs
the clinical use of placebo.
Key words
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Article info
Publication history
Accepted:
February 18,
2011
Received in revised form:
December 26,
2010
Received:
October 6,
2010
Footnotes
Supported by Grant 5R01AT001424-06 to Dr. Michael Robinson, from the National Center for Complementary and Alternative Medicine (NCCAM) of the NIH.
The authors have no conflicts of interest to declare.
Identification
Copyright
© 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.
