E-Book | February 25, 2020

Analgesia eBook: The Placebo Problem

By Michael Kuss and Scott Millard

Patient with pill in hand (002)

For hundreds of years, the medical community has known that the mere act of receiving treatment, even if it’s just a sugar pill, can improve a patient’s symptoms. Therefore, in order to ensure that the effects of an experimental treatment are real, most randomized controlled trials (RCTs) include a placebo arm.

Placebos are most often pharmacologically inactive pills that mimic the physical characteristics of the study drug, but they can also take the form of inert medical devices, sham surgeries, and fake acupuncture. The placebo effect is broader than just patient improvement in response to this inactive treatment; it encompasses the patient’s response to the entire therapeutic context in which treatment is administered.

In this eBook, we examine issues surrounding the placebo response and its rise in more detail. Section One explores how and why the placebo effect is growing over time, and concludes with a brief history of the placebo. Section Two turns to the underlying psychological, neurobiological, and genetic mechanisms responsible for the placebo response. Section Three examines how the placebo response can be accurately measured in studies, its relationship to drug effects, and a few disease-related factors that contribute to it. Section Four discusses the latest research on strategies to reduce the placebo response, and the many factors that can influence its magnitude. Section Five covers a few other placebo-related topics: the placebo’s opposite – the nocebo effect – where the brain’s response to treatment context negatively impacts health; the placebo response in pediatric populations; and ends with some ethical considerations of placebo use.

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