The Importance of Placebo Effects in Pain Treatment and Research

TLDR

Placebo responses are highly variable, can mimic active treatments, and are influenced by anxiety, expectations, and learning, yet their true mechanisms remain poorly understood. The study aims to quantify the magnitude, duration, and influencing conditions of placebo effects in pain treatment and research. The authors conducted a systematic literature review of MEDLINE and PsycLIT from 1980–1993, supplemented by bibliography review and expert consultation, selecting studies relevant to placebo effects in pain.

Abstract

To estimate the importance and implications of placebo effects in pain treatment and research from the existing literature, with emphasis on their magnitude and duration, the conditions influencing them, and proposed explanations.English-language articles and books identified through MEDLINE (1980 through 1993) and PsycLIT (1967 through 1993) database searching, bibliography review, and expert consultation.Articles were included if they pertained to the review objectives.Placebo response rates vary greatly and are frequently much higher than the often-cited one third. Placebos have time-effect curves, and peak, cumulative, and carryover effects similar to those of active medications. As with medication, surgery can produce substantial placebo effects, and this possibility is commonly overlooked in case series reports on back surgery. Individuals are not consistent in their placebo responses, and a placebo-responder personality has not been identified. Models advanced to explain placebo effects emphasize the role of anxiety, expectations, and learning.Placebo effects influence patient outcomes after any treatment, including surgery, that the clinician and patient believe is effective. Placebo effects plus disease natural history and regression to the mean can result in high rates of good outcomes, which may be misattributed to specific treatment effects. The true causes of improvements in pain after treatment remain unknown in the absence of independently evaluated randomized controlled trials.