A Comparison of Deceptive and Non-Deceptive Placebo Analgesia: Efficacy and Ethical Consequences
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ORIGINAL ARTICLE
A Comparison of Deceptive and Non-Deceptive Placebo Analgesia: Efficacy and Ethical Consequences Jennifer M. Mundt, MS 1 & Daniela Roditi, PhD 2 & Michael E. Robinson, PhD 1
# The Society of Behavioral Medicine 2016
Abstract Background Research has demonstrated the efficacy of analgesic placebos. The manner in which they are usually delivered deceptively raises questions about their impact on recipients. However, there has been little empirical investigation into the potential harms of analgesic placebo. Moreover, the role of deception in determining the magnitude of analgesic placebo response remains poorly understood. Purpose This study aimed to investigate the consequences of deceptive placebo analgesia in terms of ethical/psychological effects and efficacy. Methods Healthy adults (N = 75) were randomized to a control group, deceptive placebo manipulation, or non-deceptive placebo manipulation. All participants underwent repeated pain testing using a thermal stimulus. Placebo manipulation groups underwent placebo conditioning involving a cream that was described as being either analgesic or inert. Statespecific negative mood and attitudes toward research and pain treatment were assessed before and after placebo conditioning. Results Deceptive and non-deceptive placebo manipulations yielded pain ratings that did not differ significantly from one another but did differ from those of the control group, which experienced a pain sensitization response across trials. Results Electronic supplementary material The online version of this article (doi:10.1007/s12160-016-9854-0) contains supplementary material, which is available to authorized users. * Michael E. Robinson [email protected] 1
Clinical and Health Psychology, University of Florida, PO Box 100165, Gainesville, FL 32610, USA
2
Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
thus indicated that both deceptive and non-deceptive placebo manipulations prevented pain sensitization. Across groups, the participants reported improved depression, anxiety, frustration, and fear. The use of placebo did not negatively impact participants’ attitudes and beliefs about research or pain treatments. The participants tended to rate several parameters related to research participation more positively after participating in our study. Conclusions Our results indicate that the placebo manipulation groups experienced an anti-sensitization effect. The use of analgesic placebo did not result in any detrimental ethical or psychological effects. Keywords Placebo analgesia . Deception . Ethics . Pain
Introduction The use of analgesic placebos in clinical care has been well documented, as have the efficacy and potential mechanisms [1, 2]. Typically, these placebos are delivered in a deceptive manner whereby the patients are unaware that they are receiving a placebo for their pain. This body of research indicates that placebos using enhanced expectations and conditioning for pain relief are most effective [3, 4]. Despite the wealth of
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