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Placebos help against chronic back pain
One study showed that placebos can help with pain therapy - even if the study participants are aware that they are placebos. Placebo treatment helped relieve the pain of people with chronic back pain and made them feel “fitter” and less depressed.
Everyone knows back pain. The complaints of some people, however, clearly exceed the "normal level". According to an older message from the University Hospital Essen, the pain persists for more than six months in up to 20 percent of cases and is then considered chronic. Researchers from Essen wanted to know if and how placebos could help. They found that the agents work without active ingredients.
Pain relieving effect about as high as that of an NSAID
Although placebos do not contain any drug, they can still contribute to medical treatment. The so-called placebo effect was also part of various scientific studies. Its benefits have now been clearly demonstrated for back pain.
As the Deutsche Gesellschaft für Neurologie e.V. (DGN) wrote in a recent communication, a study by the University Medical Center in Essen showed that patients with chronic back pain benefit from therapy with placebos.
According to the data, the pain-relieving effect of the placebos was approximately as high as that of an NSAID (non-steroidal anti-inflammatory drug). "It is worth integrating the placebo effect into existing therapy concepts," says DGN press officer Professor Dr. med. Hans-Christoph Diener.
The study results were published in the specialist magazine "Pain".
Participants knew they were taking placebos
The 127 patients who had suffered from back pain for at least twelve weeks were divided into two groups. One group (60 people) received the same treatment as before, the second (67 people) received an additional placebo twice daily for 21 days.
Before the start of the study, a video was presented to all study participants, which provided information about the so-called placebo effect and the latest study situation on possible positive effects of open placebo administration.
The subjects were therefore informed that they were taking an active ingredient-free substance. The participants in the comparison group were assured that they could also receive a placebo application after the end of the study.
According to the information, the groups did not differ significantly in age, gender and pain intensity at the time of enrollment, but the BMI was higher in the group that was also treated with placebo (28.18 compared to 25.72).
Patients were less depressed
The study examined, on the one hand, the treatment experiences reported by the patient, such as pain relief and functional impairment in everyday life ("patient reported outcomes"), but also objective criteria such as the mobility of the spine with regard to the extent and speed of movement, which were carried out with sensors on the patient Spine were measured.
As stated in the communication, pain intensity as the subjective parameter was the primary endpoint, secondary endpoints were pain-related limitation, depression, anxiety and stress, which were assessed using standardized questionnaires.
As a result, the group treated with placebos showed a significantly greater decrease in pain intensity, felt less functionally impaired and indicated that they were less depressed.
In addition, the trend of patients treated with placebo asked less about emergency medication, i.e. additional pain relievers. The objective parameters, however, were not different between the groups.
Chronic back pain fluctuates in intensity
But how can it be explained that placebos could significantly improve subjective well-being, even though the study participants even knew that they had received placebos, ie capsules completely free of active ingredients?
Dr. Julian Kleine-Borgmann, first author of the study, and project manager Prof. Ulrike Bingel argue that the mechanisms of an open placebo application have not yet been sufficiently researched.
Patients may have developed unconscious positive expectations regarding placebo from the information video, although the measured expectation in the placebo group was not significantly related to pain relief.
Another hypothesis is the reinterpretation of so-called natural fluctuations: It is known that chronic back pain fluctuates in intensity over the course. Less painful phases may lead to positive expectations being fulfilled in the sense of a “self-fulfilling prophecy”, which further reinforces the belief in a positive effect of the placebo.
Therapeutic potential should be investigated further
The research group believes that the therapeutic potential of placebos should be further investigated. DGN Press Officer Professor Dr. Hans-Christoph Diener goes one step further:
"It is worth integrating the placebo effect more closely into existing therapy concepts. This includes a positive presentation of the expected therapeutic success. ”The expert emphasizes that in chronic pain disorders the psyche plays an important role and can influence the subjective feeling of pain.
"If we can significantly reduce the subjective pain burden of the patient - even if only with some of the patients - through an educational video and the addition of the placebo effect, we should use this option," said the expert.
"Chronic pain patients have enormous suffering, which wears them down physically and mentally. A therapy that leads to a subjective improvement is justified - even if we do not yet fully understand the underlying mechanisms," summarizes Prof. Diener. (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- German Society for Neurology (DGN): Placebos improved the well-being of patients with chronic back pain, (accessed: February 4, 2020), German Society for Neurology (DGN)
- Kleine-Borgmann J, Schmidt K, Hellmann A, Bingel U: Effects of open-label placebo on pain, functional disability, and spine mobility in patients with chronic back pain: a randomized controlled trial; in: Pain, (published: December 2019; 160 (12): 2891-2897), Pain
- Essen University Hospital: Looking for volunteers: Can placebos relieve back pain ?, (accessed: February 4, 2020), Essen University Hospital