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Perspectives

Clinical use of placebo in pain management

Duncan Sanders, Damien Finniss

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© VADIMGUZHVA/ISTOCKPHOTO.COM
© VADIMGUZHVA/ISTOCKPHOTO.COM

Abstract

Modern research has demonstrated multiple specific biological effects following placebo administration in experimental and clinical settings. There is now a challenge to reconceptualise placebo effects as valid psychobiological processes, recognising their presence even if a traditional placebo is not given.

Key Points

  • Placebo effects are part of every healthcare encounter, even if no placebo is given, because the therapeutic ritual is the trigger for placebo mechanisms.
  • There are multiple placebo effects, each with unique psychobiological mechanisms.
  • There is a shift from deceptive administration of placebo to targeting components of the therapeutic ritual to harness placebo effects (in combination with usual care). Furthermore, initial research augmenting nondeceptive prescription of placebo pills with usual care is promising.
  • Understanding placebo effects can improve outcomes for all interventions.
  • Nocebo effects can inadvertently lead to increased morbidity and mortality.
  • Nocebo effects may play a role when swapping from a branded to a generic medication, so careful exploration of contextual factors may be important in this process.

Figures

© VADIMGUZHVA/ISTOCKPHOTO.COM
© VADIMGUZHVA/ISTOCKPHOTO.COM