Placebo acceptability in chronic pain patients: More dependent on application mode and resulting condition than on individual factors

Abstract

IntroductionPlacebo effects can be very effective in certain pain conditions, but their use is still highly controversial. Several studies show that patients would accept a placebo treatment under certain circumstances, particularly when they are informed prior to the treatment or when there are no effective treatment alternatives. This study examines the question, which factors influence the degree of acceptability of a hypothetical placebo application.MethodsPatients filled in a questionnaire dealing with placebo applications. Moreover general data, diagnosis, duration of pain, pain ratings and anxiety/depression/stress scores, sleep disorders and opioid intake were collected from the patients` charts. 129 patients (44 men / 85 women, mean age 51.5 years, 18.0–80.9 years) entered the study. All patients had chronic pain syndromes and were treated in an universitary academic interdisciplinary pain center. Mean duration of pain was 14.7 years.ResultsThe study did not show significant differences in placebo acceptability among patients with different pain diagnoses or accompanying psychological diagnoses or disorders. Hidden placebo application was considered much more unacceptable for the patients than the enhanced placebo or the open placebo application. An improved condition was associated with less feeling of deception, more trust and less negative mood than an unchanged or worsened condition.ConclusionAcceptance of placebo as pain therapy is much more dependent on the way of application (hidden or open) or on the resulting condition (improved, unchanged or worsened) than on factors inherent in the individual patients.

The Knowledge of Contextual Factors as Triggers of Placebo and Nocebo Effects in Patients With Musculoskeletal Pain: Findings From a National Survey

“…As for communication, the majority of Italian patients desired transparent information about CFs. In line with previous surveys (26, 30, 37–38, 39, 44), our result confirms the need to notify patients without lying when they receive a non-specific treatment. Communication is a central aspect of the patient–clinician relationship and constitutes one of the most important CFs capable of triggering placebo or nocebo response with a relevant effect on clinical outcomes (2).…”

“…Our participants considered as non-ethical the deceptive use of CFs. In accordance with previous surveys on placebo (26, 33, 34, 38, 44), deception was considered negatively as it determines a violation of the patients’ autonomy and right to be informed about the treatment delivered. Indeed, it can compromise the trust towards clinicians particularly when deceptive treatment resulted in negative outcomes (37, 39).…”

“…From a clinical perspective, the patient’s point of view about CFs has been proposed as a central line of investigation (25). Up to now, qualitative and quantitative researches have investigated the participants’ point of view towards placebo using focus groups (26, 27), interviews (28–30), and surveys (31–39–44). Studies have been performed in different countries such as the US (28, 29, 32–33, 34, 38, 39), Asia (27, 42, 43), Australia (36), and Europe (26, 30, 31, 35, 37, 40, 41, 44), involving healthy subjects (26, 27, 32, 34, 41–43) and patients with acute/chronic health conditions (30, 36–39, 40, 44), depression (43), irritable bowel syndrome (28, 29), and rheumatic and musculoskeletal pain (31, 33, 35).…”

“…Up to now, qualitative and quantitative researches have investigated the participants’ point of view towards placebo using focus groups (26, 27), interviews (28–30), and surveys (31–39–44). Studies have been performed in different countries such as the US (28, 29, 32–33, 34, 38, 39), Asia (27, 42, 43), Australia (36), and Europe (26, 30, 31, 35, 37, 40, 41, 44), involving healthy subjects (26, 27, 32, 34, 41–43) and patients with acute/chronic health conditions (30, 36–39, 40, 44), depression (43), irritable bowel syndrome (28, 29), and rheumatic and musculoskeletal pain (31, 33, 35). Overall, findings revealed a) a heterogeneous understanding of placebo effects, ranging from limited (27, 32, 33, 35, 36, 40) to well-expressed knowledge (30, 31, 37, 39); b) a dualistic conceptualization of placebo effects, as a beneficial element to be legitimized or as ineffective (26, 28); and c) an open vision about placebos in clinical practice, revealing the deception and the lack of informed consent as major ethical issues of their use (27, 30, 32–38, 39, 44).…”

Open-label placebos: A systematic review and meta-analysis of experimental studies with non-clinical samples

“…Patients, on the other hand, seem more open to this novel use of placebos. For example, in a study of placebo acceptability in patients with chronic pain, respondents indicated that they preferred open-label placebos to deceptive placebos 39 . The patients' desire for transparency aligns with the calls of leading placebo researchers who oppose the use of deceptive placebos in clinical practice 40 .…”