Placebos and Pain Management: Can Using a Placebo Help Treat Chronic Pain?
Key takeaways:
A placebo is a pill or treatment that has no active ingredients or medication. But in some cases, placebos have been shown to improve health. This is known as the placebo effect.
When it comes to placebos and pain management, research shows that the placebo effect can lead to pain relief. But the placebo effect doesn’t occur in everyone.
Placebos aren’t recommended over traditional treatments, including medications, for chronic pain. But if your healthcare professional wants to try a placebo for pain management, they can do so only with your consent.
Experiencing pain is vital. It alerts us when something is wrong in our body and encourages us to seek care. But for many people, pain continues for months or years after an injury or other pain-inducing event. This is called chronic pain. It’s estimated that chronic pain affects more people than diabetes, cancer, and heart disease combined.
If you’ve been living with chronic pain, you may have tried many treatments for pain relief. But what about a placebo? That’s right: a pill with no medication in it. Could taking essentially nothing improve your pain? Here, we cover the latest research on placebos and pain management.
Defining placebo and the placebo effect
A placebo is a “treatment” that has no established effect on the body. Researchers often compare placebos with active treatments to determine whether the treatment is having an effect.
Search and compare options
The placebo effect is when someone taking a placebo has a response to it — often an improvement in health. On the other hand, the nocebo effect is when a placebo makes you feel worse. With both the placebo and nocebo effects, your feelings about taking a particular treatment — even if you’re taking a placebo — influence how it affects you.
Can the placebo effect work even if you know you’re taking a placebo?
It’s possible that a placebo will work. Studies using an open-label placebo (OLP) design — when people taking a placebo know they’re taking it — have shown that the placebo effect can still happen for a wide range of conditions, including lower back pain, migraines, and nasal allergies.
Can placebos work for chronic pain?
It’s possible that the placebo effect can improve chronic pain. It does this in two main ways:
Placebos can cause psychological changes — this is where your thoughts and emotions about a placebo can influence how you respond to it.
Placebos may change the balance of neurotransmitters (brain chemicals) in your brain, which influence how you perceive pain.
We’ll dive into these two mechanisms below.
Psychological changes
There are two major theories about why placebos can cause psychological changes.
Expectations: Believing a treatment will work can increase your chances of that treatment actually working. The same goes for placebos. For example, pain research shows that receiving a placebo in a clinical trial is often as effective as receiving the active pain treatment. But some research also shows that a placebo can work even if you don’t believe it will, especially in chronic pain.
Conditioning: This is the idea that you can link two things together in your brain without realizing it. For example, if your body is used to feeling pain relief after taking a pain medication, you may feel similar relief after taking a placebo medication. In this case, your brain is linking the act of taking medication to the feeling of pain relief.
Other factors can also influence your perception of pain. For example, some research shows that having a positive relationship with a healthcare professional can improve the placebo effect for pain-related conditions.
Effect on neurotransmitters
Placebos may reset the brain-body connection that’s disrupted in chronic pain. This may dial down how intensely your body experiences pain. To understand how this happens, we first need to understand why chronic pain occurs.
In some cases, chronic pain is caused by ongoing health conditions that cause physical pain. In other cases, chronic pain may be caused by a faulty connection between the body and the brain. In this situation, an injury or a health condition triggers a pain sensation initially. Stress, emotional pain, and traumatic events can also cause physical pain. Usually, this pain sensation goes away over time. But in chronic pain, your body continues to fire pain signals. Prior pain experiences and expectations about pain can also contribute to ongoing chronic pain.
This is where placebos might help. Placebos may activate several neurotransmitters involved in the pain experience. Activating these chemicals can decrease how intensely you feel physical pain. These chemicals can also improve your feelings about your pain. The affected chemicals include:
Dopamine, a natural feel-good hormone associated with pleasure
Endorphins, which are potent pain relievers
Endocannabinoids, which relax your muscles and reduce stress
Oxytocin, which may facilitate pain relief through feelings of social connectedness
Are placebos used for pain relief?
Not usually. This is because placebos aren’t recommended over traditional treatments for chronic pain. Depending on what type of pain you have, effective treatments may include over-the-counter pain relievers, such as ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). It may also include prescription medications, such as opioids or gabapentin (Neurontin). Mental health therapy and physical therapy are also effective pain treatments in some cases.
Placebo research is ongoing, and it’s still unclear how healthcare professionals can ethically use placebos in practice. Researchers are also still trying to understand why some people respond to placebos but others don’t. One method that’s been studied is using placebos in place of pain medication (such as opioids) for a certain amount of doses per day. This may reduce how much pain medication you need.
Ethical considerations for using placebos in chronic pain
Placebos have a history of being used as a form of medical gaslighting. In these cases, patients’ symptoms were dismissed as not being real, and health professionals may have administered placebos because they didn’t believe a patient’s symptoms were real. Patients were often left unheard, undiagnosed, and undertreated. Some experts are concerned about history repeating itself even if OLPs are used.
This is why the American Medical Association offers ethical guidance on the use of placebos, which includes the following rules:
Anyone receiving a placebo has to agree to it.
The exact timing of when you’ll receive a placebo can be unknown if you agree to it. This may increase your chances of feeling a placebo effect.
Placebos should be used only if they have the potential to benefit you. They shouldn’t be used to appease you or simply to make a healthcare professional’s job easier.
The bottom line
A placebo is a “sham” treatment that has no known effect on the body. The placebo effect is when someone taking a placebo has a response to it that you’d expect from an active treatment.
Some research shows that the placebo effect can be used to improve chronic pain. But placebos aren’t recommended over traditional pain medications and nonmedication treatment options.
If you or your healthcare professional is interested in trying a placebo for chronic pain, you can receive one only if you agree to it. A healthcare professional can’t use a placebo to treat any medical condition without your knowledge.
Why trust our experts?
References
AMA Code of Ethics. (n.d.). Use of placebo in clinical practice. American Medical Association.
Blease, C., et al. Are open-label placebos ethical? Informed consent and ethical equivocations. Bioethics.
Carvalho, C., et al. (2016). Open-label placebo treatment in chronic low back pain: A randomized controlled trial. Pain.
Colloca, L., et al. (2017). Relieving pain using dose-extending placebos: A scoping review. Pain.
Drusko, A., et al. (2023). A novel computational approach to pain perception modelling within a Bayesian framework using quantitative sensory testing. Scientific Reports.
Dydyk, A. M., et al. (2023). Central pain syndrome. StatPearls.
Institute of Medicine Committee on Advancing Pain Research, Care, and Education. (2011). Introduction. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. The National Academies Press.
Itskovich, E., et al. (2022). Oxytocin and the social facilitation of placebo effects. Molecular Psychiatry.
Kam-Hansen, S., et al. (2014). Labeling of medication and placebo alters the outcome of episodic migraine attacks. Science Translational Medicine.
Kaptchuk, T. J. (2018). Open-label placebo: Reflections on a research agenda. Perspectives in Biology and Medicine.
Kaptchuk, T. J., et al. (2020). Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice. BMJ.
Marchant, J. (2015). Strong placebo response thwarts painkiller trials. Nature.
Perfitt, J. S., et al. (2020). Placebo effect in the management of chronic pain. BJA Education.
Rehman, I., et al (2023). Classical conditioning. StatPearls.
Rossettini, G. et al. (2023). The biology of placebo and nocebo effects on experimental and chronic pain: State of the art. Journal of Clinical Medicine.
Schaefer, M., et al. (2023). A randomized controlled trial of effects of open-label placebo compared to double-blind placebo and treatment-as-usual on symptoms of allergic rhinitis. Scientific Reports.
Sullivan, L. S. (2020). Does consent make open label placebo research ethical? Journal of Medical Ethics.
von Wernsdorff, M., et al. (2021). Effects of open-label placebos in clinical trials: A systematic review and meta-analysis. Scientific Reports.
