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Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research

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Open-Label Placebo Injection for Chronic Back Pain With Functional Neuroimaging: A Randomized Clinical Trial.

Yoni K Ashar¹, Michael Sun², Karen Knight³

¹Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora.

JAMA Network Open

|September 11, 2024

Summary

Open-label placebos (OLPs) reduced chronic back pain intensity for one month and improved mood and sleep for a year. Neuroimaging revealed OLP engagement of brain pain-modulatory pathways, offering a non-deceptive therapeutic option.

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Area of Science:

Pain Medicine
Neuroscience
Clinical Trials

Background:

Chronic back pain (CBP) is a major cause of disability, with placebos often showing efficacy comparable to active treatments.
Open-label placebos (OLPs), administered without deception, present a potential avenue for CBP relief, but their mechanisms require further investigation.

Purpose of the Study:

To evaluate the long-term effectiveness of OLPs for CBP.
To explore the neurobiological underpinnings of OLP treatment in CBP patients.

Main Methods:

A randomized clinical trial involving 101 adults with CBP, comparing OLP (saline injection with placebo information) to usual care.
Longitudinal functional magnetic resonance imaging (fMRI) was used to assess brain activity and connectivity before and after treatment.
Follow-up extended to 1 year, with primary outcome as pain intensity at 1 month.

Main Results:

OLP significantly reduced CBP intensity at 1 month post-treatment compared to usual care (P=.02).
While immediate pain relief from OLP did not persist long-term, significant improvements were noted in depression, anxiety, anger, and sleep quality up to 1 year.
fMRI revealed OLP altered brain responses to pain, engaging prefrontal-brainstem pain modulatory pathways.

Conclusions:

A single OLP injection can effectively reduce CBP intensity in the short term and offer sustained psychological and sleep benefits.
The neurobiological effects of OLPs in CBP patients involve established pain-modulatory brain networks, similar to deceptive placebos.
OLPs represent a promising non-deceptive therapeutic strategy for chronic pain management.