Would you take a sugar pill to relieve pain? Someday, doctors might be able to identify patients that could benefit from taking a placebo to treat chronic pain, rather than relying on opioids that may cause dependence.Want Help for Chronic Pain? Try Sugar Pills
A recent study published this month in Nature Communications has found that a person’s brain anatomy, brain function, and personality predict how likely they are to respond to a placebo.
The “placebo response” describes the relief from symptoms that some people feel after taking a pill or other treatment that contains no active medication.
Researchers have long known that some people are more likely to experience a placebo response than others. However, few studies have identified traits that predict this response.
“It’s been assumed that [the placebo response] is not predictable, has no real physiology, and is instead a sort of statistical artifact,” Apkar Vania Apkarian, PhD, lead investigator of the study and a professor of physiology at Northwestern University Feinberg School of Medicine in Chicago, told Healthline.
“But if we can predict it,” he said, “then it is feasible to be a real treatment option.”
Half of people responded to a placebo
To explore the predictability of the placebo response, Apkarian and colleagues conducted a double-blind clinical trial in more than 60 people with chronic back pain.
Forty-three of those people received treatment with a placebo, five received treatment with active medication, and the remaining 20 received no treatment at all.
Among those treated with a placebo, 56 percent reported reductions in pain. On average, their pain decreased by 33 percent.
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According to psychological tests, those who responded to a placebo were more emotionally aware, sensitive to their environment, and open to experience than those who didn’t respond.
Neuroimaging scans also showed differences in the brain structure and function of placebo responders, compared to non-responders.
The implications of these findings are “huge,” Dr. Luana Colloca, PhD, MS, a neuroscientist at the University of Maryland School of Nursing, told Healthline.
“I found it quite inspiring that they divided patients into responders and non-responders to really look at what makes a participant, a patient, benefit from placebos,” she said.
“That is quite important, not only to make changes in the way we run clinical trials,” she explained, “but also make changes in clinical practice.”
Placebos might provide an alternative to opioids
Past studies have shown that a placebo can relieve pain in a portion of people with diverse conditions, including arthritis, fibromyalgia, chronic back pain, and irritable bowel syndrome.
In many cases, participants in those studies didn’t know if they were taking a placebo or active medication.
However, a growing body of research suggests that some people benefit from using a placebo even when they know it contains no active ingredients. This is known as an open-label or “honest” placebo.
“The more we study this phenomena, the more it looks like the ritual of taking a pill can be important to trigger this sort of response in the brain, this sort of self-healing mechanism,” Colloca explained.
“Any strategy that can harness this ability of the brain to inhibit pain has a huge value,” she added, “especially now in the years of the opioid epidemic.”
Opioid addiction is a growing problem in the United States, where an estimated 8 to 12 percent of people who are prescribed opioids for chronic pain develop an opioid use disorder.
For some people with chronic pain, placebos might provide adequate relief without the risk of addiction, overdose, or other adverse side effects.
“While many doctors and researchers agree with the push to move away from opioid prescribing, the fact remains that millions of Americans struggle with chronic pain, and we need to be thoughtful about providing safe evidence-based treatment options,” Michael Bernstein, PhD, a postdoctoral fellow at the Center for Alcohol & Addiction Studies at Brown University, told Healthline.
“Honest placebos are safe and appear to be effective,” he continued. “With more research to confirm these initial findings, it could become a useful clinical tool among health practitioners looking for alternatives to opioid medication.”
Barriers to using placebos
To help doctors identify which patients are most likely to respond to a placebo, Apkarian and colleagues hope to develop more simplified methods and tools than those used in their study.
“Ideally,” he said, “we will produce a very simple metric, for example, that a physician can give to a patient who walks in, ask five or ten questions, and from those questions, decide whether the subject will respond to placebo and how much they will respond.”
“Then,” he continued, “they will tell them directly, ‘my assessment tells me that psychologically or physiologically, you are primed to respond to this, so why don’t you take this for the next few months, and let’s see how much your pain is relieved.’”
According to ethical standards established by the American Medical Association, doctors may only use a placebo to treat a patient if they have the patient’s cooperation and consent to do so.
Some doctors may be reluctant to try placebos as a treatment strategy, Bernstein said.
“For years, a defining feature of placebo in medical dictionaries was a medicine given to please, rather than benefit, a patient,” he explained. “Although work supporting the effectiveness of placebos is mounting, ‘placebo effect’ remains a pejorative term in some circles.”
The bottom line
A new study has found that a person’s brain anatomy, brain function, and may predict if a placebo will lead to pain relief.
The “placebo response” describes the relief from symptoms that some people feel after taking a pill or other treatment that contains no active medication.
In this study, 56 percent of participants reported less chronic pain after taking a placebo. On average, their pain decreased by 33 percent.
Those who responded to a placebo were more emotionally aware, sensitive to their environment, and open to experience than those who didn’t respond.
