Astounding effect: drug-free placebos relieve chronic back pain – even if patients know that they only get a placebo. This is now confirmed by a study in Essen. After taking placebo pills for three weeks, the patients experienced significant pain relief, needed less painkillers less often and felt less depressed. It is therefore worthwhile to include the placebo effect in therapies, the researchers say.
Whether sugar pill, saline syringe or pseudo-surgery: placebos contain no active ingredients and should not do anything objectively, but do it anyway. Studies repeatedly show that placebo treatments not only cause psychological effects, but also trigger physiologically measurable changes in the body. Interestingly, such sham treatment often works even when patients know they are getting a placebo.
Placebo instead of real medication
The placebo effect also seems to have a good effect on the number one condition, chronic back pain, as a study on 127 back pain patients has now confirmed. Doctors led by Julian Kleine-Borgmann from the University Hospital Essen had initially shown all patients an information film about the placebo effect and possible positive effects of open placebo administration. Then half of the patients were treated as before, the other received an additional placebo pill twice a day.
All patients in the placebo group knew that they were on an inactive agent. Over the course of the three-week study period, the researchers examined both objective parameters such as spinal mobility and the use of additional pain relievers, as well as subjective values. Patients were regularly asked about their pain intensity, the impairment in everyday life from back pain and also about psychological complaints such as depression, anxiety and stress.
Significant pain relief
The result: Although the patients knew that they only received a placebo, the treatment worked. The participants in the placebo group rated their pain after the three weeks as significantly less than their colleagues in the control group. On average, the difference was around 60 percent. They found the effect of the placebo to be as strong as that of a classic pain reliever, as the researchers report.
This positive effect was also shown by the fact that placebo patients needed additional pain relievers less frequently. In the standardized surveys, the test subjects also stated that they felt fitter and less physically restricted when taking the placebos. They also suffered less from depression. In contrast, the objective parameters were not different between the groups, said Kleine-Borgmann and his team.
Unconscious positive expectations
The interesting thing about it: The placebo effect was shown, although the patients knew that it was only a sham treatment. At the same time, the researchers did not find any significantly increased positive expectations among the patients even after the video was shown. So how did the placebo work? As the scientists emphasize, the mechanisms behind the placebo effect have not yet been elucidated.
One possibility would be that the information about the placebo effect had led to an unconscious positive expectation. Another hypothesis would be a changed response to natural fluctuations in pain intensity: Patients interpret phases of less pain as an effect of the placebo and this triggers positive expectations in the sense of a “self-fulfilling prophecy”.
“Integrate placebos more strongly into therapy concepts”
According to the medical team, the results underline that placebos can have real medical effects. “Our study demonstrates that open placebo treatment is safe and well tolerated and can reduce pain, impairment, and depressive symptoms in patients with chronic back pain,” said Kleine-Borgmann and his team. Placebos could therefore complement conventional therapies.
“It is worth integrating the placebo effect more closely into existing therapy concepts,” commented Hans-Christoph Diener from the German Society for Neurology. “Chronic pain patients have enormous suffering, which wears them down physically and mentally. Therapy that leads to a subjective improvement is therefore justified – even if we do not yet fully understand the underlying mechanisms. ”(Pain, 2019; doi: 10.1097 / j.pain.0000000000001683)
Source: German Society for Neurology
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