Theoretical Medicine

, Volume 12, Issue 3, pp 247–270 | Cite as

Implications of placebo theory for clinical research and practice in pain management

  • Connie Peck
  • Grahame Coleman
Article

Abstract

We review three possible theoretical mechanisms for the placebo effect: conditioning, expectancy and endogenous opiates and consider the implications of the first two for clinical research and practice in the area of pain management. Methodological issues in the use of placebos as controls are discussed and include subtractive versus additive expectancy effects, no treatment controls, active placebo controls, the balanced placebo design, between- versus within-group designs, triple blind methodology and the double expectancy design. Therapeutically, the possibility of shaping negative placebo responses through placebo sag, overservicing and the use of placebos on their own are explored. Suggestions for using conditioned placebos strategically in conjunction with nonplacebos are made and ways of maximizing the placebo component of nonplacebo treatments are examined. Finally, the importance of investigating the placebo effect in its own right is advocated in order to better understand the long-neglected psychological aspects of the therapeutic transaction.

Key words

clinical research conditioning theory endogenous opiates expectancy theory methodology of placebo controls pain management placebo design placebo effect 

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Copyright information

© Kluwer Academic Publishers 1991

Authors and Affiliations

  • Connie Peck
    • 1
  • Grahame Coleman
    • 1
  1. 1.Department of PsychologyLa Trobe UniversityBundooraAustralia

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