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. Although the ethics of therapeutic placebo use are highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments and patients may be open to these interventions in 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 in which they rated their knowledge of placebo and its efficacy for alleviating pain, evaluated the acceptability of placebo analgesic interventions across several unique medical contexts, and responded to 6 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 its 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, contrary to popular belief, patients may be rather pragmatic in their appraisals of placebo treatment acceptability, and may consider a variety of treatments/contexts as ethically 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.

Keywords: Musculoskeletal pain; Placebo; Placebo acceptability; Placebo analgesia.

Conflict of interest statement

The authors have no conflicts of interests.

Published by Elsevier B.V.

Figures

Figure 1

Deception. The influence of treatment descriptions/instructions and treatment outcomes on appraisal of treatment deceptiveness in six hypothetical placebo intervention scenarios. There was a significant main effect of treatment outcome but not treatment instructions. * = significant main effect (p < .05); error bars are 95% confidence intervals.

Figure 2

Trust. The influence of treatment descriptions/instructions and treatment outcomes on participants’ trust in their healthcare provider in six hypothetical placebo intervention scenarios. There was significant main effect for treatment instructions and treatment outcomes. * = significant main effect (p < .05); error bars are 95% confidence intervals.

Figure 3

Negative Mood. The influence of treatment descriptions/instructions and treatment outcomes on participants’ negative mood in six hypothetical placebo intervention scenarios. There was significant main effect for treatment instructions and treatment outcomes, and a significant instructions x outcome interaction. * = significant main effect (p < .05); † = significant main interaction (p < .05) error bars are 95% confidence intervals.