Placebo use in pain management: The role of medical context, treatment efficacy, and deception in determining placebo acceptability

Abstract

Placebo effects can act as powerful pain relievers. While the ethics of therapeutic placebo use is highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments, and patients may be open to these interventions under certain contexts. This investigation used a patient-centered approach to answer essential questions about placebo treatment acceptability. People with chronic musculoskeletal pain completed a placebo survey where they: 1) rated their knowledge of placebo and its efficacy for alleviating pain; 2) evaluated the acceptability of a placebo analgesic interventions across several unique medical contexts; and 3) responded to six different patient-physician treatment scenarios to assess the role of deception and placebo effectiveness on mood and provider trust. Results showed that participants had limited knowledge of placebo and it’s efficacy for alleviating pain. Placebo acceptability was highly dependent on the context of the intervention, as placebo treatments were considered acceptable when used as complementary/adjunct treatments and when no other established treatments were available. Also, an analgesic placebo response mitigated the negative consequences of deception by improving provider trust and decreasing negative mood. These findings suggest that patients may be rather pragmatic in their appraisals of placebo treatment acceptability and may consider a variety of treatments/contexts as permissible for managing their pain. This is the first study of its kind to quantify perceptions of placebo analgesia knowledge and efficacy among individuals with chronic pain, and to assess the role of different medical contexts in treatment acceptability.

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

“…After completing demographic and pain assessment questionnaires, the remainder of the study constituted a pretest/posttest design comprised of three sections (Figure 1): 1) placebo knowledge section; 2) placebo acceptability section; and 3) treatment scenarios section. Pretest findings have been published [16]. Participants completed the survey twice consecutively; after completing the initial pretest sections, participants were randomly assigned to receive either an educational intervention about placebo analgesia or control educational information about musculoskeletal pain.…”

“…VAS ratings produced numerical values between 0 and 100 and have shown to be valid and reliable measures of pain and other subjective experiences [20,32]. For the development of survey sections and measures, please see prior studies by our research group [16–18]. …”

“…One study demonstrated that a placebo treatment could be delivered with limited deception and still produce clinically meaningful symptoms relief [15]. A recent study by our research group explored placebo analgesia knowledge and acceptability for patient with chronic pain [16]. Consistent with the extant literature, patients were open to placebo analgesic treatments under certain medical contexts, such as when they are explicitly used to compliment another treatment.…”

Placebo disclosure does not result in negative changes in mood or attitudes towards health care or the provider

“…Consequently, deception in and of itself is not necessarily negative [28] and particularly if provided with therapeutic intentions. Furthermore, deception by a health care provider with the goal of lessening pain may be acceptable to patients [29][30][31].…”

“…A previous study surveyed 57 participants with chronic musculoskeletal pain regarding the acceptability of placebo treatment in clinical practice [29] and found concern was mitigated by improved clinical outcomes suggesting deception was acceptable as long as improvements in clinical outcomes resulted. Our findings add to this body of knowledge as we found small, but significant associations between two-week improvements in disability and more positive changes in mood following disclosure of having received a placebo intervention.…”