Conditioned Open-Label Placebos Provide Pain Relief in Some Post-Surgical Patients Interview with:
Kristin Schreiber, MD, PhD
Neuroscientist and Clinical Regional Anesthesiologist
Brigham and Women’s Hospital
Assistant Professor of Anesthesia
Harvard Medical School  What is the background for this study?

Response: Traditionally, the placebo effect has involved deceiving patients, where they think they may be taking a real medication. “Open-label placebos” are when placebos are given to patients, and patient are told that they are in fact a placebo. Recent research has suggested that these open-label placebos may actually reduce a number of symptoms in patients, including chronic low back pain. We were interested whether this strategy could be used to help reduce pain and opioid use around the time of surgery. We decided to combine the use of OLP with a conditioning approach, so that anytime a patient took an opioid analgesic, they would take the open-label placebo, so that the OLP pills would be associated with pain relief. That way when patients took them on their own, it would serve to trigger an expectation of pain relief, which is thought to at least partially explain the placebo effect.  

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Recorded Music plus Text During Anesthesia Reduced Need for Pain Medication Interview with:
Prof. Dr. Ernil Hansen
Department of Anesthesiology
University Hospital Regensburg
Regensburg, Germany

Prof. Dr. Hansen What is the background for this study? What are the main findings?

Response: It is becoming more and more clear that besides drugs and surgery it is communication that makes therapy effective. A meta-analysis we had conducted recently, suggested some beneficial effects of taped words played during surgery in older studies.

Our current study on 385 patients showed evidence that a text based on hypnotherapeutic principles an reduce postoperative pain and use of opioids. Pain within the first 24h after surgery decreased by 25%, opioid requirement by 34%. Six patients needed to be treated to save one patient from opioid exposure at all. High demand for analgesics was reduced by 41%. 

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5-Year Follow-Up of Open-Label Placebo Trial for Chronic Low Back Pain Relief Interview with:
Claudia Carvalho, PhD
Instituto Universitário de Ciências Psicológicas
Social e da Vida
Lisbon, Portugal What is the background for this study? What are the main findings?

Response:  Some clinical trials on chronic pain have shown placebo responses that rival those of commonly prescribed first-line therapies for low back pain (LBP).  However, prescribing placebos would pose ethical problems in clinical practice.  One solution to this problem is the use of open label placebos (OLP), which are presented to patients openly as pills without active ingredients, along with a rationale indicating that because of classical conditioning of relief with active medications, the pills themselves might reduce pain. OLP has been shown effective compared to treatment-as-usual for a number of clinical conditions, including chronic LBP.  Having conducted the first clinical trial on OLP on back pain, my colleagues and I wondered whether the effects were long-lasting. To answer that question, we conducted a five-year follow-up on the patients who had received OLP for their back pain.

In our original study, patients who took OLP pills for three weeks experienced greater reduction in back pain intensity and in back pain related disability than patients that simply continued their usual treatment. Additionally, after this phase of the trial, we offered OLP to participants  in the treatment as usual group) and they also reported a significant reductions in pain and disability, together with a spontaneous decrease in the use of pain medication by participants.

In our current follow-up, we found that patients who had taken OLP for three weeks had maintained their reductions in pain and disability 5 years later. In addition, pain medication usage was reduced by 49%. This follow-up study is currently in press (

Can Placebos Be Effective Even If We Know It’s Not a ‘Real’ Drug?

pain relief placebos

Darwin A. Guevarra, Ph.D.
Postdoctoral Fellow
Michigan State University  What is the background for this study?  What are the main findings?

Response: Placebos are these inactive treatments that often work because people believe they are taking a real treatment. For the most part, they have real beneficial effects. However, there’s a utility-ethical issue when it comes to placebos. On one hand, they reliably work in managing daily nonclinical nuisance like emotional distress and even a host of clinical ailments like pain and depression. But, it seems like you have to lie to people that they’re taking a real treatment in order to get placebos to work. As it turns out though, there’s over a dozen studies showing that placebos can still work even when people are fully aware they are taking them. These studies educate participants about the placebo effects, how they work, and how they can probably still work even when people know they are taking one. This really opens up the possibility of ethically harnessing the beneficial effects of placebos. But there’s one glaring issue. These studies that found positive effects of non-deceptive placebos only show it with self-report and no studies show beneficial effects on biological measures. This casts some doubt on whether these self-reported beneficial effects are real.

Our study wanted to test if we can observe non-deceptive placebo effects on objective biological markers. In this case, we used a neural measure called the late positive potential that can track emotional distress. We find that non-deceptive placebos do reduce self-reported, but more importantly, neural measures of emotional distress.