A comparison of placebo effects in clinical analgesic trials versus studies of placebo analgesia.
A previous meta-analysis of clinical analgesic trial studies showed generally low magnitudes of placebo analgesia (N. Engl. J. Med. 344 (2001) 1594). However, as studies included in their analysis used only placebo as a control condition, we conducted two meta-analyses, one in which 23 studies used only placebo as a control condition, and one in which 14 studies investigated placebo analgesic mechanisms. Magnitudes of placebo analgesic effects were much higher in the latter (mean effect size=0.95) as compared to the former (mean effect size=0.15) and were significantly different (P=0.003). This difference as well as differences in effect sizes within studies of placebo mechanisms may be parsimoniously explained by differences in expected pain levels produced by placebo suggestions and by conditioning. Furthermore, some of the studies of placebo analgesic mechanisms indicate that the magnitude of placebo analgesia is higher when the placebo analgesic effect is induced via suggestion combined with conditioning than via suggestion alone or conditioning alone. Based on these findings, we suggest that placebo analgesic effects are most optimally conceptualized in terms of perception of the placebo agent, and therefore a new definition of placebo response is proposed.
Vase
Lene
L
Department of Psychology, University of Aarhus, Asylvej 4, 8240 Risskov, Denmark Division of Public Health Service and Research, College of Dentistry, University of Florida, PO Box 100404, Gainesville, FL 32610-0404, USA Departments of Oral and Maxillofacial Surgery and Neuroscience, Health Science Center, University of Florida, PO Box 100416, Gainesville, FL 32610-0416, USA.
Riley
Joseph L
JL
Price
Donald D
DD
D000698:Analgesia / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D002986:Clinical Trials as Topic / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D010147:Pain Measurement / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D015990:Placebo Effect