title: Placebo use in pain management: The role of medical context, treatment efficacy, and deception in determining placebo acceptability.
abstract: Placebo effects can act as powerful pain relievers. Although the ethics of therapeutic placebo use are highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments and patients may be open to these interventions in certain contexts. This investigation used a patient-centered approach to answer essential questions about placebo treatment acceptability. People with chronic musculoskeletal pain completed a placebo survey in which they rated their knowledge of placebo and its efficacy for alleviating pain, evaluated the acceptability of placebo analgesic interventions across several unique medical contexts, and responded to 6 different patient-physician treatment scenarios to assess the role of deception and placebo effectiveness on mood and provider trust. Results showed that participants had limited knowledge of placebo and its efficacy for alleviating pain. Placebo acceptability was highly dependent on the context of the intervention, as placebo treatments were considered acceptable when used as complementary/adjunct treatments and when no other established treatments were available. Also, an analgesic placebo response mitigated the negative consequences of deception by improving provider trust and decreasing negative mood. These findings suggest that, contrary to popular belief, patients may be rather pragmatic in their appraisals of placebo treatment acceptability, and may consider a variety of treatments/contexts as ethically permissible for managing their pain. This is the first study of its kind to quantify perceptions of placebo analgesia knowledge and efficacy among individuals with chronic pain, and to assess the role of different medical contexts in treatment acceptability.
authors.affiliation: Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA Department of Psychiatry and Health Behavior, Georgia Regents University, Augusta, GA, USA Department of Anesthesiology, University of Florida, Gainesville, FL, USA Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Nkaku
authors.initials: N
authors.lastname: Kisaalita
authors.forename: Roland
authors.initials: R
authors.lastname: Staud
authors.forename: Robert
authors.initials: R
authors.lastname: Hurley
authors.forename: Michael
authors.initials: M
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000704:Analysis of Variance; D008192:Deception; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000523:psychology* / Q000628:therapy*; D059408:Pain Management; D010147:Pain Measurement; D015990:Placebo Effect; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D035502:Trust / Q000523:psychology
chemical_list: D000700:Analgesics
keywords: Musculoskeletal pain; Placebo; Placebo acceptability; Placebo analgesia