Beliefs About Pharmaceutical Medicines and Natural Remedies Explain Individual Variation in Placebo Analgesia

  • Andrew Watkinson
    Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, United Kingdom
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  • Sarah C.E. Chapman
    Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, United Kingdom
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  • Rob Horne
    Address reprint requests to Professor Rob Horne, PhD, Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, Tavistock Square, London WC1H 9JP, United Kingdom.
    Centre for Behavioural Medicine, Department of Practice and Policy, UCL School of Pharmacy, University College London, London, United Kingdom
    Search for articles by this author


      • Treatment beliefs offer an additional approach to understanding placebo analgesia.
      • Variation in placebo analgesia was predicted by pre-treatment necessity beliefs.
      • Treatment necessity beliefs were informed by general treatment beliefs and beliefs about the pain.
      • Perceived sensitivity to the effects of medicines was associated with larger placebo analgesia.


      This study examined whether placebo responses were predicted by a theoretical model of specific and general treatment beliefs. Using a randomized crossover, experimental design (168 healthy individuals) we assessed whether responses to a cold pressor task were influenced by 2 placebo creams described as pharmaceutical versus natural. We assessed whether placebo responses were predicted by pretreatment beliefs about the treatments (placebo) and by beliefs about the pain. The efficacy of pharmaceutical as well as natural placebos in reducing pain intensity was predicted by aspects of pain catastrophizing including feelings of helplessness (pharmaceutical: B = .03, P < .01, natural: B = .02, P < .05) and magnification of pain (pharmaceutical: B = .04, P < .05, natural: B = .05, P < .05) but also by pretreatment necessity beliefs (pharmaceutical: B = .21, P < .01, natural: B = .16, P < .05) and, for the pharmaceutical condition, by more general beliefs about personal sensitivity to pharmaceuticals (B = .14, P < .05). Treatment necessity beliefs also partially mediated the effects of helplessness on placebo responses. Treatment necessity beliefs for the pharmaceutical placebo were influenced by general pharmaceutical beliefs whereas necessity beliefs for the natural placebo were informed by general background beliefs about holistic treatments. Our findings show that treatment beliefs influence the placebo effect suggesting that they may offer an additional approach for understanding the placebo effect.


      Placebo effects contribute to responses to active analgesics. Understanding how beliefs about different types of treatment influence placebo analgesia may be useful in understanding variations in treatment response. Using the cold pressor paradigm we found that placebo analgesia was influenced by beliefs about natural remedies, pharmaceutical medicines, and about pain.

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