Placebo effects can act as powerful pain relievers. While the ethics of therapeutic placebo use is highly controversial, recent evidence suggests that medical providers frequently utilize placebo treatments, and patients may be open to these interventions under 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 where they: 1) rated their knowledge of placebo and its efficacy for alleviating pain; 2) evaluated the acceptability of a placebo analgesic interventions across several unique medical contexts; and 3) responded to six 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 it’s 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 patients may be rather pragmatic in their appraisals of placebo treatment acceptability and may consider a variety of treatments/contexts as 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.
A burgeoning body of evidence supports the efficacy and elucidates the mechanisms of placebo analgesia. Debate persists, however, concerning their ethical use, with many of the present arguments being philosophically-based. The present web-based study empirically investigated the acceptability of an analgesic placebo treatment. Participants (103) responded to vignettes depicting patients receiving a placebo analgesic. We experimentally manipulated 1) placebo treatment instructions (level of deception), 2) treatment outcome, and 3) patients’ pain severity. Participants rated vignettes on outcome measures of deception, physician-patient relationship, and patient mood. Participants then characterized a range of placebo acceptability through ratings of deceptiveness, effectiveness, and negative consequences. Results showed that placebos described as “medication shown to be a powerful analgesic in some people” were equally deceptive as those described as “standard drug treatment.” Ratings of patient mood and physician approval were determined as much by treatment instruction as by treatment outcome and an analgesic response mitigated the negative consequences of deceptive administration. Participants tolerated moderate effectiveness and considerable negative consequences in an acceptable placebo, although results suggest lay individuals may not have a sophisticated conceptualization of placebo effectiveness. Studies altering individuals’ understanding of placebo effectiveness and mechanisms are needed to identify additional factors determining placebo acceptability.
Context Sickle cell disease (SCD) is an inherited hematological disease marked by intense pain. Early in life the pain is episodic, but it becomes increasingly chronic in many cases. Little is known about this emergence of a chronic pain state. Objectives The goal of this study was to determine whether adult SCD patients whose pain is still largely episodic show early signs of the disturbed pain processing (hyperalgesia, increased temporal summation) and cognition (hypervigilance and catastrophizing) that are characteristic of a chronic pain state. Methods SCD patients (n=22) and healthy controls (n=52) received noxious pressure stimulation for up to three minutes, and periodically reported pain intensity and unpleasantness on 0–10 scales, allowing the rate of pain increase (temporal summation) to be determined. Pain intensity discrimination also was measured, and attitudes toward pain were assessed. Results There were no overall differences in pain ratings or temporal summation between patient and control groups. However, patients’ experimental pain ratings tended to increase with age, and those reporting a history of very painful episodes showed particularly rapid temporal summation of pain unpleasantness. Patients were significantly impaired at discriminating intensities of noxious stimulation. Patients were more hypervigilant than controls, but catastrophizing was elevated only during pain episodes. Conclusion Most SCD patients whose pain remits entirely between episodes are not in a chronic pain state, but some—those who are older and have a history of highly painful episodes—appear to be transitioning into it. These early signs of disturbed processing may aid clinicians seeking to forestall disease progression.
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