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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Article info
Publication history
Published online: November 18, 2015
Accepted:
October 24,
2015
Received in revised form:
October 20,
2015
Received:
August 19,
2015
Footnotes
This work was supported by Grant 5R01AT001424-06 to (M.E.R.) from the National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health.
The authors have no conflicts of interest to declare.
Identification
Copyright
Published by Elsevier Inc.
