Placebos are frequently used as a way to record, evaluate, and understand pain management. But are placebos and pain management a good combination? Here, we look at the pros and cons of placebos from the perspectives of researchers and chronic pain patients.
How Do Placebos for Pain Control Work?
In order to understand the effectiveness of a medication, usually there are trials completed. In these controlled environments, a group of people is given the real medication and the other group is given the placebo. Then, everybody would report on the effectiveness of the pill regarding how it helps (or doesn’t help) pain.
This is where the placebo effect comes into play. The placebo effect is a scientifically proven phenomenon that occurs when somebody believes that a medical intervention is going to work—like a pain medication—and therefore feels its benefits, even though nothing is changing physiologically. Most times, placebos are sugar pills. There’s no actual medication that can be absorbed into the body.
In some cases, the people taking placebos know that the medication they are taking isn’t “real”—or they at least know that there is a chance they will get the placebo in research settings. However, a lot of people don’t know that they are receiving a placebo. The outcomes of this vary from the placebo doing nothing to decrease the pain to the placebo being helpful for pain management.
So how does this happen? Well, researchers believe that some people are genetically predisposed to the effects of a placebo. This means that they are more likely to believe and feel that the medication they are getting is working, even if it’s not real.
What Are the Pros and Cons to Placebos?
Scientists have done a lot of research on the relationships between placebos and pain management, specifically in clinical practice and outside of a research setting. Let’s break down some of the biggest pros and cons to placebos in clinical practice.
One of the biggest benefits to placebos and pain management is that placebos are non-habit forming. This means that people with chronic pain aren’t going to be at risk of developing an addiction or physical dependency. Opioids, which are also used for pain management, come with a high risk of addiction. Unfortunately, this leads to serious health consequences and increases the chance of overdose. When looking at the risks vs. benefits of placebos for pain management, this is certainly a benefit.
Another thing to keep in mind is that there is a connection between pain and mental health. Researchers believe that having hope that a treatment is going to work (even if it’s a placebo) can increase someone’s mood. In turn, they might feel as though they are more able to do what they need to do, physically and emotionally.
Placebos in clinical settings also offer a unique perspective into the power of believing. This is something that can’t easily be quantified but is a topic that many researchers hope to discover more about.
Ultimately, the goal of pain management interventions is to offer the patient relief. If this relief comes in the form of a placebo, the question remains: Does it matter? Some patients feel that as long as they are getting relief from the pain, the method of getting there, as long as it is safe, is of no consequence.
Perhaps the biggest con to keep in mind when it comes to placebos and pain management would be the ethics of it. Regardless of the results, is it ethical to tell a patient that their pain is going to be treated and then give them a placebo that will have no biological impact on them? In truth, the answer to this question will vary depending on who you speak to.
While placebos can help experts to understand more about pain, placebos can also be seen as deceitful. This can easily hurt the trust of patients who go into a clinical practice hoping to receive treatment for pain.
Of course, the other downside to placebos would be that they do not provide any physiological treatment for patients. This leaves many patients where they started: in pain and searching for solutions.
One study shows that placebos can be useful, but should be done only when patients are aware of the circumstances and in settings where they have already built a safe, trusting relationship with the provider. In the end, it comes down to trust—and for a chronic pain patient, this trust can make or break the way that somebody is able to cope with constant pain.
A Personal Perspective on Placebos and Trust
I have lived with chronic pain for almost 15 years. During this time, I’ve tried a variety of methods to manage the pain: pain medication, yoga, cognitive behavioral therapy (CBT), diet changes, physical therapy, alternating heat and ice, even just falling asleep and hoping to wake up with some relief—you name it, I’ve tried it.
I was fortunate to receive a diagnosis of Ehlers-Danlos Syndrome (EDS) only months after the pain started—but the specialist who diagnosed me told me that EDS doesn’t cause pain. She told me that I was looking for attention. She said it was all in my head. I was only 13 years old.
At this young age, my trust in doctors was suddenly shattered. And worst of all: I started to doubt myself. This self doubt of “Am I really in pain? What if this is all in my head?” turned from silly worries into paralyzing anxiety.
Many people who have chronic pain go through similar experiences and still don’t have an answer for their pain. This usually means going from one specialist to the next. And with that comes the worries. Will the doctor listen? Will they believe me? Will they try to treat me? Will I have to do this all over again?
It’s hard to find providers we trust as chronic pain patients. And when we do, we have to trust with our whole being that they will do everything they can to help us. If we go into a treatment plan with false hope and come out on the other side to learn that the medication was a placebo all along, it will probably only further the distrust that can happen between patients and doctors.
But this isn’t to say that the placebo response can’t—in some cases—help patients who are out of options. Chronic pain treatment isn’t one-size fits all. It should be uniquely built for each individual patient. So, what works for some might not work for others. As stated above, the end goal is to find pain relief, whether that’s through pain medication, counseling, or even just seeking support from a community that understands.
Perhaps the best solution to the ethical dilemma of placebos and pain management is to make sure that patients have access to all options and all information. This is the only way that patients can give full, informed consent about any treatments, procedures, or other medical interventions that they undergo. This way, you would be left to decide for yourself if you’d be willing to trust the placebo response for the chance to feel relief.
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