Knowingly Taking a Placebo May Decrease Chronic Back Pain
Written by Editor   
Wednesday, November 23, 2016 12:00 AM
News Bite: The use of open-label placebo in chronic low back pain patients has been demonstrated to result in significant reductions in pain and improvement of disability after three weeks.  Placebo pills, even with the patient's knowledge of the placebo, may be a useful addition to the treatment of chronic low back pain.  

Even when patients with chronic back pain know they are taking a placebo, the treatment can reduce both their pain and disability, new research suggests.  In the study of 83 adults in Portugal with persistent low back pain, those who received open-label placebo therapy plus “treatment as usual" for 3 weeks had significantly greater single and composite reduction scores on 3 different pain scales compared with those who received only treatment as usual.  The placebo group also showed significant reductions in disability scores.

In addition, all of these improvements were found in the participants originally assigned to treatment as usual alone and then switched to the placebo pills for an additional 3 weeks.  The take-home message is that prescribing placebo openly is a possibility, although we need to look more at what conditions that’s true for in order to replicate the results.  This could be especially useful in conditions with medical treatments that do not provide enough benefit. Anything that boosts that would be helpful.

Low back pain…causes more disability than any other medical condition worldwide and researchers and clinicians have identified a pressing need for innovative treatments and management tools. Several recent studies have shown inferiority or “only marginal increased efficacy" for low back pain medications vs placebo. 

Many people have believed that a placebo would work only if patients didn't know that that's what they were taking. But some small pilot studies and an irritable bowel syndrome trial have shown that open-label placebo prescriptions can provide benefit.

Our findings suggest that open-label placebo pills presented in a positive context may be helpful in chronic low back pain, the researchers report.  They add that this is the first study to show potentially clinically significant benefits from this type of treatment in this patient group. 

This study reopens the discussion about placebo effects in medicine and whether it is ethical to use it as a treatment approach for patients with chronic conditions.

“The effects of…clinician interactions can enhance the effects of drugs. Therefore, what this study really shows is that the information provided to patients and the predictable ritual of taking a pill are important components of care.” 

The study did bring some useful information on how to manage some chronic conditions in primary care. "One possibility is to use an open-label placebo treatment as a 'wait and watch' strategy before prescribing strong opioids, which are often associated with serious adverse events."

More studies are needed before this management approach becomes applicable in clinical practice, the researchers concluded.