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Key points
- A placebo is a pill or other seemingly medical treatment that contains zero medicinal ingredients.
- In a June 2021 study, psychological and medical researchers explored how to harness the power of placebos to reduce post-operative pain.
- Psychologists, working with physicians, are applying the new placebo techniques to combat almost all types of chronic pain.
Looking for relief from chronic pain? Discomfort in a shoulder, back, neck, the gut, or fibromyalgia all over a body is no fun. While opioids can be a pain relief option, they raise the specter of an additional problem, i.e., addiction. A surprising solution that researchers have been testing offers new hope.
In a study published in the journal Pain in June 2021, ten researchers working together found that strategically used placebos could enable patients recovering from spine surgery to experience a reduced need for opioid analgesics.
Placebos are fake treatments, in this case, fake pills. They look like pills, but they have the same amount of medicine in them as your favorite candy. That is, they are pills with zero medicinal ingredients.
Yet, believe it or not, the Pain study has found that when they are prescribed in a particular way, administration of placebo pills—in addition to and eventually in some cases instead of—real medicine, can radically reduce chronic pain. With less pain, patients also need less potentially addictive opioid pain medication.
How was the potency of placebos—fake medicine—discovered?
Dr. Henry Beecher, the founder of modern-day placebo use, learned first-hand about the potential pain-killer effects of placebo pills during World War II. A field medic responsible for caring for wounded soldiers, Dr. Beecher, often found to his dismay that too few pain-killing medicines had been sent to him.
At one point, when he needed to operate on a wounded soldier, Dr. Beecher realized that he had no anesthesia left at all. What could he do?
Determined to save the man's life, Dr. Beecher ordered a nurse to fill a syringe with saline solution (saltwater) and then lie to the soldier by saying that the syringe gave him morphine. Amazingly, the soldier reported experiencing barely any pain—and Dr. Beecher was able to accomplish the surgery.
After this success, Dr. Beecher repeated this "placebo" procedure every time he ran out of morphine.
The ethical challenge of placebo use.
Why are psychologists and research physicians working together to find ways to harness the power of placebo effects?
- Placebos are cheap.
- They have no side effects.
- And placebos are non-addictive.
Yet placebos do violate a fundamental principle of modern medicine: to be honest and transparent with patients. It would be unethical for a physician to tell a patient, "We are giving you a drug," when the so-called medicine is, in fact, just a sugar pill.
A win-win solution that makes using placebos honest and ethical.
Drs. Kelsey Flowers, Ted Kaptchuk, and their colleagues at Boston's Brigham and Women's Hospital tested a new way of administering placebos. They called the method “open-label placebo” use.
The doctors prescribed fake "pills," telling the patients outright that the pills were placebo. They explained that previous studies have found open-label placebos to be effective. Patients were told that open-label placebos could “automatically activate your body’s natural healing responses,” even if they knew they were placebo.
This information creates a mindset in which open-label placebos can have therapeutic benefits. Amazingly, prior studies have established that even when patients knew they would be taking sugar pills, placebo "medicines" could effectively alleviate a wide range of symptoms.
Did placebos reduce the amount of pain medication that patients needed?
The study's authors recruited 51 patients scheduled for spine surgery at Brigham and Woman’s Hospital in Boston, Massachusetts. After the surgery, patients were randomly assigned to one of two conditions.
Half the patients were given the usual pain-relief regime of morphine to manage their post-operative pain.
The other half of the patients received a novel open-label placebo-based treatment. These patients were instructed to take a sugar pill every time they took the morphine.
Adding the placebo pills were designed to teach patients to associate their sugar pills with the effects of morphine, just like Pavlov’s dogs learned to associate a bell with food. Pavlov's dogs learned to salivate on hearing the bell even without seeing actual food. Patients were instructed to take the sugar pill three times a day. Would patients' subconsciously learn to experience less pain by taking the placebo pills with their morphine?
What did the open-label placebo study find?
Patients in the placebo group reported feeling lower levels of post-surgical pain. They also used 30% less morphine than patients in the typical morphine condition. Women and younger patients appeared to be particularly responsive to this treatment method.
Do drug-mimicking effects of placebos occur in clinical as well as research settings?
Building on research, pain psychologists are already implementing open-label placebo procedures to address a wide range of forms of chronic pain. For instance, psychologists Abigail Hirsch, Ph.D. and Yoni Ashar, Ph.D., utilize open-label placebo techniques as one of the treatment options in their online chronic pain relief program.
Dr. Hirsch explained,
As psychologists, we have been delighted with the potency of the psychological effect of pairing sugar pills with actual pain-killing medicines. Most of our chronic pain patients really do find that they can taper off from their long-term use of pain medications, with many becoming totally drug-free and pain-free.
In conclusion
Researchers Flowers et al. effectively showed that open-label placebo administration could, in many cases, significantly reduce the amount of medication that spine surgery patients need to relieve their post-surgical pain. Combining psychological savvy with medical treatments is definitely opening up new pathways for many who struggle with chronic pain to find their way from suffering to health.
