STUDY: Knowingly Taking Placebo Reduces Chronic Back Pain

STUDY: Knowingly Taking Placebo Reduces Chronic Back Pain

by Staff

A new study published in the journal PAIN shows that knowingly taking fake pills can significantly reduce pain and disability for people who suffer with chronic low back pain.

That’s right, “knowingly” taking fake pills can reduce pain.  It’s common to see placebos used in clinical studies, but the study participant does not know if he or she is taking a real medicine or a placebo.  In this case, one study group is told they are taking a placebo.

This is the first study to demonstrate that patients who knowingly took a placebo in conjunction with traditional treatment for lower back pain saw more improvement than those given traditional treatment alone.

“These findings turn our understanding of the placebo effect on its head,” said joint senior author Ted Kaptchuk, director of the Program for Placebo Studies and the Therapeutic Encounter at Beth Israel Deaconess Medical Center and an associate professor of medicine at Harvard Medical School in a press release.

“This new research demonstrates that the placebo effect is not necessarily elicited by patients’ conscious expectation that they are getting an active medicine, as long thought.  Taking a pill in the context of a patient-clinician relationship – even if you know it’s a placebo – is a ritual that changes symptoms and probably activates regions of the brain that modulate symptoms,” he added.

The researchers studied 97 people with chronic lower back pain (cLBP), which causes more disability than any other medical condition worldwide.  After all participants were screened and examined by a registered nurse practitioner and board certified pain specialist, the researchers gave all patients a 15-minute explanation of the placebo effect.  Only then was the group randomized into one of two groups; the treatment-as-usual (TAU) group or the open-label placebo (OLP) group.

The vast majority of participants in both groups (between 85 and 88 percent) were already taking medications – mostly non-steroidal anti-inflammatories (NSAIDS) – for their pain.  (Patients taking opioid medications were excluded from the trial.)  Participants in both the TAU and OLP groups were allowed to continue taking these drugs, but were required not to change dosages or make any other major lifestyle changes, such as starting an exercise plan or new medication, which could impact their pain.

In addition, patients in the OLP group were given a medicine bottle labeled “placebo pills” with directions to take two capsules containing only microcrystalline cellulose and no active medication twice daily.

At the end of their three-week course of pills, the OLP group overall reported 30 percent reductions in both usual pain and maximum pain, compared to 9 percent and 16 percent reductions, respectively, for the TAU group.  The group taking placebo pills also saw a 29 percent drop in pain-related disability. Those receiving treatment as usual saw almost no improvement by that measure.

“It’s the benefit of being immersed in treatment: interacting with a physician or nurse, taking pills, all the rituals and symbols of our healthcare system,” Kaptchuk said.  “The body responds to that.”

“Our findings demonstrate the placebo effect can be elicited without deception,” said lead author, Claudia Carvalho, PhD, of ISPA.  “Patients were interested in what would happen and enjoyed this novel approach to their pain.  They felt empowered.”

Kaptchuk speculates that other conditions with symptoms and complaints that are based on self-observation (like other kinds of pain, fatigue, depression, common digestive or urinary symptoms) may also be modulated by open-label treatment.

“You’re never going to shrink a tumor or unclog an artery with placebo intervention,” he said.  “It’s not a cure-all, but it makes people feel better, for sure.  Our lab is saying you can’t throw the placebo into the trash can.  It has clinical meaning, it’s statically significant, and it relieves patients.  It’s essential to what medicine means.”

“Taking placebo pills to relieve symptoms without a warm and empathic relationship with a health-care provider relationship probably would not work,” noted Carvalho.

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Authored by: Staff

There are 13 comments for this article
  1. Tim Mason at 3:48 pm

    Emely, these people writing and formulating these studies are digging up on information of the web to get a masters degree or some other grand funded award. If you dig deep enough you will see that these papers border on plagiarism and fraud. They are nothing short of the freshman English research paper.
    Believe none of what you read and only have of those things you see. And of those you see, only believe the ones you understand.

  2. Emily Raven at 6:10 am

    I said something about this study being taken to mean people will start saying “a placebo can reduce pain” as fact (just like every other study…look at how things are pushed through the FDA with disastrous results alone) and got dragged for saying so; “it’s just a study; you should be open-minded” etc…. Now we have an article stating it as fact. Like I said before, give it six months and it’ll be standard to shove it down our throats at pain clinics just like all the other mind game “treatments” that fail those of us with actual mechanical and tissue problems.

    Someone called this sway towards saying pain is in the brain we must fix the brain period nothing else as “neurocentric”. I have to agree. I’m tired of all these “cutting edge” studies that dredge up old disproven bs and get grabbed as fact by doctors that shouldn’t be in the profession let alone making guidelines and rules.

  3. John at 11:26 am

    Anymore i find that even the caring and nice bedside manner is pretty much gone. The chronic pain centers that I have visited in the years that I have lived like this are filled with practitioners that are mostly nasty and rude. I believe that this does contribute to the chronic pain patient’s belief that the illness is their fault, contributes to their stress levels, and angers the patient, really. My point is this- I can see a caring type of visit having the opposite effect on the patient.
    Mention of the DEA is so common that I think the stress of having this specter hanging over their jobs and licenses is just making them crazy.
    That, and the seemingly prevailing attitude that anyone that uses pain relievers must be a downright scuzzy individual makes visits to obtain pain meds pretty much unbearable.
    I am trying once again to live without them and hoping against hope that the pain doesn’t arrive, but I know it will. I have my arsenal of TENS unit that i have applied to my upper calf, Baclofen for the dope sickness, acetaminophen, medical marijuana and anti-diarrheal.
    By the way, I suffer from peripheral neuropathy- my feet are numb and if the numbness isn’t controlled it morphs into severe pain.
    I was forced into this latest attempt to quit opioids by my use of Medical Marijuana, which anyone prescribing opioids are forced to test for by rule of the DEA. My state has made it legal however. The Feds are still in my life all over, and now they are prescribing my medications.
    No thanks, I’ve been smoking marijuana all my adult life and hang me if they are going to be the ones to make me quit.
    So if this attempt doesn’t work, I will be forced to look for street drugs for pain management. I’ve been very sick of this treatment for some time now anyway.

  4. Deb Burt at 5:15 pm

    Perhaps it was the last sentence ‘the warm and empathic relationship with the health care provider” more than the placebo.

  5. Tim Mason at 10:23 am

    Clearly it was the “micro crystalline cellulose” that relieved the back aches.
    Reports of studies like this are “tabloid-ish” and are obviously printed for humor.
    Many more like this one and the “Wheelchair bound, fibromyalgia, crps patient with the flu that swam a mile because she had stamina, and I will be gone from this blog.

  6. Anne Fuqua at 12:33 am

    That’s just plain bizarre. I DO understand that there IS definitely a placebo effect. This is just bizarre that these people could have such improvement while knowing that they were taking placebo! I sure wish that it would help me that much to do that. I can sort of understand theory about how it could help- but 30% seems drastic. Next thing you know Ballantyne and her buddies will add this to the CDC Guidelines and say they have evidence it’s just as much relief as most people get from opioids. I wonder if there is something unique in the psychological makeup of this group. Do they have anything in common that makes them more or less suggestible? More likely to want to please researchers by demonstrating improvement????

  7. connie at 1:39 pm

    I have an idea for a study… Apply a pair of pliers to a very tender part of the anatomy of people who believe this crud and without removing them offer a placebo for the “discomfort. When they are rolling on the floor in pain remind them that the pain can be controlled with their mind and walk away. I wonder how many could control the pain with a placebo and their minds? don’t forget to tell them that they can’t possibly be in pain since no one else can feel it!

  8. Sandy M. at 12:10 pm

    Did you notice that those taking opioids were not included in the trial? I just thought that was rather strange that it was for those with low back pain, not us with back SURGERY pain. And, I’m not putting down anyone with low back pain, I understand low back pain, I had it for 20 years before I finally had to do something about it and went into pain management where all they did was give me injections, and procedures that never worked. I had a diskogram, that was the most painful procedure I’ve ever had and it proved my back was bad, but they kept saying it was L5-Sl or L4-5 They would tell me one thing, then another, different disks, tears, etc., It wasn’t until 2013 when I went to a university hospital, had a series of x-rays done, about 24 the first time, that I found out I had a deformed back and Scoliosis was progressing so fast within the first 3 months of doing x-rays they did on me that I had surgery for Scoliosis..I changed my mind twice, but was afraid we would lose my husband’s insurance, which we did this year, that I decided to have the surgery. During the first test, they found I had a 90% blockage in my right ooronary artery, which I had to have a stent inserted before they could do the back surgery, so I am sure someone up above was looking after me. I am more upright than before, my pain is some better, but, wow, I am still in pain and unable to do exercises, I try to walk, but it hurts so bad to walk, I feel like my legs are going to fold up under me, I have taken some falls, and my husband, even with his own back problems, tries so hard to help me.. My back has 2 steel rods from the T-3 to my L5-S1 and lower, 34 2″ screws in veterbraes and 2 4″ screws into my hip bone. A total Fusion! So yes, my back hurts plus the pain from my thalamic hemorrhage that left me with that rare, unusual, awful, 24/7 painful condition, thalamic pain syndrome, which I have told you about so many times on my entire left side, that pain is horrific, and I just don’t understand how someone in Washington can tell my doctor who has known me for years and the pain I’m in that I cannot have something to give me some relief. I tried a truckload of medicaitons before the hydromorphone (not Vicodin), 4 mg every 6-8 hours, would give me enough relief I could visit with my grandkids and get out of bed to do a few things, then back into bed with a cold pack or hot pad. I’m so crabby when I hurt and now I have to live like this. I’m glad I’m 69 years old, and I feel for all you younger people who have more years of pain than I may have. Let’s try to get something done, I will help in anyway. I have contacted my Senator and they called and left a message for me to call back, but I’m sure they will tell me he is not on that committee, we shall see. All of you take care and I pray for all of you.l..

  9. Gayle Nolen at 9:14 am

    Great idea! I will just put some Tic Tacs in an empty pill bottle and feel all better. Right……

  10. Angel at 9:05 am

    Opioids are the most effective treatment for pain the world has ever known. Instead of dealing in that reality we now see medicine defying logic defying scientific truth and reality to bring us useless studies like this one to say pain is all in our heads. Next time these study authors or our anti opioid politicians need surgery or pain intervention from disease, lets just give them a therpist and a placebo pill and remind them it is all in their heads.

  11. Tracy at 8:44 am

    What an insult to my intelligence. A waste of research resources and a puppet.

  12. connie at 6:55 am

    In other words pain is all on your head and can therefore be controlled by your mind? This sounds like the kind of pure cr*p that the powers that be jump on if the study isn’t one of their own in disguise! I am sure there are people who fit this criteria but they aren’t the ones that require real pain control!

  13. Thomas biels at 3:12 am

    Absolutely ridiculous , I’d like to see the MRI for those with a verified defect taking a placebo and reporting belief. Junk science and is meant to once again make those taking opioids feel like their something wrong in their brain other than musculoskeletal / nerve . Tired of this war on chronic pain patients