title: The magnitude of placebo analgesia effects depends on how they are conceptualized.
abstract: OBJECTIVE
  Placebo effects are usually calculated as the difference between placebo treatments and no treatments. Recently, placebo-like effects have been investigated using open and hidden administrations of active treatments. The aim of the study was to directly compare the two types of placebo effects and examine how they are influenced by personality traits.
  
  
  METHODS
  In a within-subject, randomized, blinded, balanced placebo trial design study with 48 healthy volunteers, we compared placebo and placebo-like effects and tested if expectancy, absorption and suggestibility correlated with these effects. Subjects completed the Tellegen Absorption Scale and the Sensory Suggestibility Scale, and pain was induced by injections of hypertonic saline into the masseter muscle. Participants received four injections of hypertonic saline with lidocaine or matching placebo in randomized order: open treatment, hidden treatment, placebo and control. The placebo effect was defined as the difference in pain between the placebo and the control condition and the placebo-like effect as the difference in pain between the open and hidden condition.
  
  
  RESULTS
  Placebo effects were significant both in the traditional paradigm: mean placebo effect AUC 1626 mm(2) (95% CI 958-2293) and the open-hidden paradigm: mean placebo-like effect AUC 801 mm(2) (95% CI 134-1469), but there was a significant difference between the magnitude of the two effects (p=0.049). Absorption and suggestibility did not predict the placebo or the placebo-like effect. Estimated expected pain relief correlated with placebo effects but not placebo-like effects.
  
  
  CONCLUSIONS
  The magnitude of placebo effects differs depending on how they are conceptualized and calculated.
authors.affiliation: Danish Pain Research Center, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Karen
authors.initials: K
authors.lastname: Lund
authors.affiliation: Department of Psychology, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.
authors.forename: Gitte L
authors.initials: GL
authors.lastname: Petersen
authors.affiliation: Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Mogens
authors.initials: M
authors.lastname: Erlandsen
authors.affiliation: Department of Psychology, La Sapienza, University of Rome, Rome, Italy.
authors.forename: Vilfredo
authors.initials: V
authors.lastname: De Pascalis
authors.affiliation: Department of Psychology, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.
authors.forename: Lene
authors.initials: L
authors.lastname: Vase
authors.affiliation: Danish Pain Research Center, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Troels S
authors.initials: TS
authors.lastname: Jensen
authors.affiliation: Danish Pain Research Center, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark. Electronic address: finnerup@clin.au.dk.
authors.forename: Nanna B
authors.initials: NB
authors.lastname: Finnerup
mesh_terms: D000328:Adult; D000698:Analgesia / Q000523:psychology*; D000779:Anesthetics, Local / Q000008:administration & dosage; D019540:Area Under Curve; D003210:Concept Formation; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D010146:Pain / Q000139:chemically induced / Q000188:drug therapy / Q000523:psychology*; D059408:Pain Management; D010147:Pain Measurement; D010551:Personality; D015990:Placebo Effect; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine
keywords: Absorption; Expectation; Pain; Placebo effect; Suggestibility