When used in an ethical and safe way, placebos are a great tool to help with symptom relief. Here is the section from my book on that. Btw, if you would like to read this blog as an ebook, including all future posts, then have a look at “The Placebo Cure” on Amazon.
Working through literature on placebo studies I found that placebos provide value in mainly in three areas:
- symptom relief
- performance enhancement
In addition, there are two other fields that I think could benefit from placebo use: happiness and personal growth.
One of most important benefits of placebos is that they can provide relief from symptoms – especially subjective and bothersome symptoms, such as pain.
Chronic Back Pain
Lower pack pain is one of the most common types of chronic pain. About eighty percent of adults experience low back pain sometime in their lives. Lower back pain can be the result of poor posture, injury, weight problems, arthritis, genetics, and can occur even without apparent reason. Low back pain has a far reaching impact, it
- consumes a large amount of our healthcare resources
- leads to missed work days and reduced productivity
- impairs physical function and quality of life
- comes with suffering
Lower back pain is often treated with pain relief medications such as opoid analgesics or Non-Steroidal Anti-Inflammatory Drugs (NSAID), but also with antidepressants, muscle relaxants and herbal medicines. In the majority of cases lower back pain is self-limiting – it resolves after some time without treatment.
Placebo vs. NSAID
A large review of studies which involved more than 11,000 participants with lower back pain (Roelofs, 2008) demonstrated that placebos are almost as effective as NSAIDs for short-term pain relief in patients with acute and chronic low-back pain.
Placebo vs. Antidepressant
Another review of ten clinical trials evaluating the effects of antidepressants for low-back pain showed that placebo was about as effective as anti-depressants in relieving back pain symptoms (Urquhart, 2008).
Placebo vs. Acetaminophen
A recent Australian study that was very well designed showed that placebo is just as effective as acetaminophen (Tylenol) for lower back pain (Williams, 2014). Many medical guidelines around the world recommend using acetaminophen as a First Line Treatment for sudden onset lower back pain; it is the first treatment that doctors try for a patient who was recently diagnosed.
For those who are interested, here is a little more insight into this study: 1,643 patients with acute lower back pain were randomly assigned to one of three groups. Each patient received two boxes with the following instructions:
- take two pills three times daily
- take as needed
Each group of patients received either
- only placebo
- only the active drug
- one box placebo, one box active drug
|Group||Take three times daily||Take as needed||Days until recovery|
|A||Active drug||Active drug||17|
Placebo worked as well as acetaminophen for lower back-pain during the 4 week treatment.
75% of all patients were satisfied with the treatment, regardless of the group they were in. During the study, no differences were detected between the three groups in:
- recovery time
- disability & function
- quality of life
While the placebos in this study were not taken openly, this study is important. Previous findings that pure placebo provide about the same pain relief for lower back pain as Acetaminophen may allow our mind and body to open up and engage in the placebo experience. Also, let’s note that, Acetaminophen intoxication induced liver failure is one of the most frequent causes for medication-induced intensive care admissions
There are many studies that looked at the effect of placebo on acute migraine. A recent study by Ted Kaptchuk is especially relevant, because it compared different labels for placebo to a migraine drug (Kam-Hansen, 2014). What gives this study a unique perspective is that the same patient would take a pill from envelopes that had one of three messages:
- this is a placebo
- this is the active drug
- this could be the active drug or the placebo
In all cases, regardless of what the envelope said, it could actually contain the active drug or the placebo. The main result of the study for us was:
Patients who knowingly took the placebo (open placebo) experienced an average 15% decrease in pain after 30 min. Patients who took nothing (no treatment) experienced a 15% increase in pain during the same time.
15% pain decrease vs. 15% increase is a significant and meaningful difference of open placebo vs no treatment.
There is more to this study. Other observations:
- Also after two hours, placebo did significantly better than no treatment measured on a 0 – 10 pain scale.
- Placebo provided similar pain relief regardless how it was labeled: “placebo”, “unknown”, “active drug”.
- The drug provided more pain relief than placebo, except when the active drug was labeled “placebo”.
- When patients were asked the yes/no question if their pain was completely gone after 2.5 hours there was no significant difference between placebo and no treatment .
- 30% of patients who received the active drug responded they were pain free after 2.5 hours.
Irritable Bowel Syndrome (IBS)
IBS is a good candidate to benefit from placebo effects. We already discussed a key study on open placebo use for IBS in the chapter “The Honest Placebo” (Kaptchuk, 2008)
Stress and Anxiety
Placebos have been found to be very effective for symptom relief from chronic stress and anxiety. The efficacy of Placebos in clinical trials is typically very high for anti-anxiety drugs. Because a strong placebo effect leaves little room for active drugs to show a superior effect, anti-anxiety medications have a hard time getting FDA approval (Schweizer, 1997).
A meta-analysis reviewed 19 double-blind clinical trials that enrolled a total of 2,318 patients with depression (Kirsch, 1998), found that the placebo-effect of anti-depressants accounted on average for 75% of the total treatment effect. When unpublished studies were included in a later review (Kirsch, 2008) placebos turned out to be just as effective as active drugs for mild to moderate depression.