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No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial

PainSci » bibliography » Kleine-Borgmann et al 2022
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Tags: mind

One article on PainSci cites Kleine-Borgmann 2022: Placebo Power Hype

PainSci commentary on Kleine-Borgmann 2022: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

In 2019, Kleine-Borgmann et al reported that prescribing an open-label (non-deceptive) placebo for back pain was more helpful than typical care. In this follow-up three years later, they report that the benefit did not last: “our follow-up data do not support the previously suggested assumption that a three-week open-label placebo treatment has long-term effects.” Not really a surprise.

As the authors note, “research on nondeceptive placebos is still in its early stages, and studies on long-term effects are almost nonexistent.” They present their findings primarily in contrast to the only other data of this kind: Carvalho et al’s startling conclusion that the benefits of an nondeceptive placebo were sustained for five years. However, as they acknowledged, there was a significant methodological limitation. As pointedly summarized by Kleine-Borgmann et al.:

“…because of a predefined crossover from treatment-as-usual to open-label placebo, in which all patients received OLP at the end of the study, follow-up was performed as an observational analysis without a control group, preventing causal attribution of continued improvements to OLP treatment.”

So the sensational long-term results Carvalho et al. reported were probably just an artifact — and now those results are also contradicted by this study.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Chronic low back pain is prevalent, highly disabling and a relevant socioeconomic health concern. Although allocated to placebo groups, patients in randomized controlled trials show significant pain relief, pointing to the relevance of placebo effects. Overcoming ethical and legal concerns related to deceptive placebos, recent studies have demonstrated the efficacy of short-term treatments for chronic low back pain with open-label (i.e., non-deceptive) placebos. However, data on long-term efficacy of open-label placebos are sparse. Here, we report a three-year follow-up of our previously published randomized controlled trial demonstrating pain reduction, improvement in disability and depressive symptoms after a three-week treatment with open-label placebos. Including records from N=89 previously enrolled patients, we investigated changes between the groups with and without previous open-label placebo treatment in pain intensity (primary outcome), disability and mood (secondary outcomes), biopsychosocial factors and lifestyle (exploratory outcomes) from parent baseline to follow-up. Over the three-year period, there were no differences in any outcome between groups with and without open-label placebo treatment. Therefore, our follow-up data do not support the previously suggested assumption that a three-week open-label placebo treatment has long-term effects. This study was pre-registered on April 14, 2020, in the German Clinical Trials Register (registration number DRKS00021405).

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