Is Open Labelled Placebo a Plausible Treatment for Patients with Chronic Pain? A Scoping Review
Author
Bohlmann, Sönke Dieter
Term
4. Term
Publication year
2024
Submitted on
2024-06-07
Pages
48
Abstract
Kroniske smerter rammer omkring tre ud af ti mennesker på verdensplan og medfører store personlige og samfundsøkonomiske omkostninger. Der findes mange behandlinger, men patienters forventninger kan i høj grad påvirke resultatet: placeboeffekter kan forbedre symptomer, selv når folk får at vide, at de tager en placebo. Dette studie kortlagde åben placebo (open-label placebo, OLP)—placebo givet med fuld åbenhed—og betingede åbne placeboer (conditioned open-label placebo, COLP), hvor placebo gives åbent og kobles til en indlært sammenhæng (fx tidligere parret med aktiv medicin), for at vurdere effekt, mulige virkningsmekanismer og praktisk anvendelse ved kroniske smerter. Vi fulgte PRISMA-retningslinjer for scoping reviews og søgte i PubMed, Cochrane, Embase og PsycINFO efter peer-reviewede, empiriske studier publiceret frem til marts 2024. Vi inkluderede studier af OLP ved kroniske smerter og af COLP ved smertebehandling; ikke-empiriske arbejder blev ekskluderet. Én forsker screenede referencer, udtrak data og vurderede bias-risiko. Ud af 1.432 screenede publikationer blev 16 randomiserede kontrollerede forsøg, 3 reviews og 7 kvalitative studier inkluderet. Den samlede evidenskvalitet var moderat. På tværs af studier var OLP forbundet med statistisk signifikante fald i smerteintensitet og medicinforbrug samt bedre funktion. Den kliniske betydning af disse ændringer var dog uklar. De mest konsistente gevinster sås ved kroniske sekundære smertetilstande som knæartrose og irritabel tyktarm, mens resultaterne for kroniske primære lændesmerter var blandede. Ét studie rapporterede øget brug af komplementære og alternative behandlinger blandt patienter, der modtog OLP. COLP viste potentiale for at reducere opioidforbrug efter operation, men virkningen syntes mindre hos personer med kroniske smerter. Patienter var oftere villige til at acceptere OLP og COLP, når de var dokumenteret effektive eller når andre muligheder manglede. Sundhedsprofessionelle udtrykte bekymring for etik, manglende retningslinjer og risikoen for at undergrave tilliden til sundhedsvæsenet og videnskaben. Samlet set kan OLP og COLP være lavomkostningsmuligheder for nogle med kroniske smerter, men resultaterne er blandede og afhænger muligvis af smertetype og mekanismer. Der er behov for mere forskning til at standardisere metoder og retningslinjer, undersøge langtidsvirkninger, afprøve på tværs af smertetilstande og håndtere etiske spørgsmål før klinisk implementering.
Chronic pain affects about three in ten people worldwide and brings heavy personal and societal costs. Many treatments exist, but patients’ expectations can strongly shape outcomes: placebo effects can improve symptoms even when people are told they are taking a placebo. This review examined open-label placebos (OLP)—placebos given honestly—and conditioned open-label placebos (COLP), in which a placebo is given openly and paired with a learned association (for example, previously paired with an active drug), to assess effectiveness, possible mechanisms, and practical use in chronic pain. Following PRISMA guidelines for scoping reviews, we searched PubMed, Cochrane, Embase, and PsycINFO for peer-reviewed, empirical studies published up to March 2024. We included studies on OLP in chronic pain and on COLP in pain management; non-empirical work was excluded. One researcher screened records, extracted data, and assessed risk of bias. Of 1,432 records screened, 16 randomized controlled trials, 3 reviews, and 7 qualitative studies were included. Overall evidence quality was moderate. Across studies, OLP was associated with statistically significant reductions in pain intensity and medication use and with improved function. However, the clinical importance of these changes was unclear. The most consistent benefits appeared in chronic secondary pain conditions such as knee osteoarthritis and irritable bowel syndrome, whereas findings for chronic primary low back pain were mixed. One study reported increased use of complementary and alternative treatments among patients receiving OLP. COLP showed promise for reducing opioid use after surgery, but appeared less effective for people with chronic pain. Patients tended to accept OLP and COLP when they were shown to work or when other options were lacking. Healthcare providers raised concerns about ethics, the absence of clear guidelines, and the risk of undermining trust in healthcare and science. Overall, OLP and COLP may offer low-cost options for some people with chronic pain, but results are mixed and may depend on pain type and mechanisms. Further research should standardize methods and guidance, examine long-term effects, test across different chronic pain conditions, and address ethical issues before clinical use.
[This summary has been rewritten with the help of AI based on the project's original abstract]
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