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Placebo Use in Pain Management: A Mechanism-Based Educational Intervention Enhances Placebo Treatment Acceptability

Published:November 18, 2015DOI:https://doi.org/10.1016/j.jpain.2015.10.017

      Highlights

      • Results suggest placebo analgesic effects can be large and clinically meaningful.
      • Survey assessed patient knowledge of and acceptability toward placebo treatments.
      • Patients were conditionally willing to receive placebo interventions for pain.
      • Placebos used as complementary treatments were rated as highly acceptable.
      • Education on placebo mechanisms greatly enhanced placebo acceptability.

      Abstract

      Health care providers use treatments whose effectiveness derives partially or completely from ‘nonspecific’ factors, frequently referred to as placebo effects. Although the ethics of interventional placebo use continues to be debated, evidence suggests that placebos can produce clinically meaningful analgesic effects. Burgeoning evidence suggest that patients with chronic pain might be open to placebo treatments in certain contexts despite limited knowledge of their well-established psychoneurobiological underpinnings. In this investigation we sought to examine the effects of a brief, mechanism-based placebo analgesia educational intervention on aspects placebo knowledge and acceptability. Participants with chronic musculoskeletal pain completed a web-based survey in which they rated their knowledge of placebo analgesia, assessed placebo acceptability across different medical contexts, and evaluated 6 unique patient–provider treatment scenarios to assess the role of treatment effectiveness and deception on patient–provider attributions. Using a pre–post design, participants were randomized to receive either a placebo educational intervention or an active control education. Results showed that the educational intervention greatly improved perceptions of placebo knowledge, effectiveness, and acceptability, even in deceptive treatment contexts. This was the first study of its kind to show the value of an educational intervention in increasing openness to and knowledge of placebo analgesic interventions among patients with chronic musculoskeletal pain.

      Perspective

      In this we article highlight how patients with chronic pain might be open to placebo interventions, particularly adjunct and/or complementary treatments, when provided education on the neurobiological and psychological mechanisms that underlie placebo effects. Study findings highlight ethically acceptable ways to potentially use placebo factors to enhance existing pain treatments and improve patient health outcomes.

      Key words

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