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International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 4/2023

01-08-2022 | Opioids | Full length manuscript

Experiences of Patients Taking Conditioned Open-Label Placebos for Reduction of Postoperative Pain and Opioid Exposure After Spine Surgery

Authors: Valerie Hruschak, K. Mikayla Flowers, Megan Patton, Victoria Merchantz, Emily Schwartz, Robert Edwards, Ted Kaptchuk, James Kang, Michelle Dossett, Kristin Schreiber

Published in: International Journal of Behavioral Medicine | Issue 4/2023

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Abstract

Background

Pain after spine surgery is difficult to manage, often requiring the use of opioid analgesics. While traditional “deceptive” or concealed placebo has been studied in trials and laboratory experiments, the acceptability and patient experience of taking honestly prescribed placebos, such as “open-label” placebo (non-deceptive placebo), or conditioned placebo (pairing placebo with another active pharmaceutical) is relatively unexamined.

Methods

Qualitative thematic analysis was performed using semi-structured, post-treatment interviews with spine surgery patients (n = 18) who had received conditioned open-label placebo (COLP) during the first 2–3 weeks after surgery as part of a RCT. Interview transcripts were reviewed by 3 investigators using an immersion/crystallization approach, followed by iterative large-group discussions with additional investigators, to identify, refine, and codify emergent themes.

Results

Patients’ experiences and perceptions of COLP efficacy varied widely. Some emergent themes included the power of the mind over pain, how COLP might provide distraction from or agency over pain, bandwidth required and engagement with COLP, and its modulation of opioid tapering, as well as negative attitudes toward opioids and pill taking in general. Other themes included uncertainty about COLP efficacy, observations of how personality may relate to COLP efficacy, and a recognition of the greater impact of COLP on reduction of opioid use rather than on pain itself. Interestingly, participant uncertainty, disbelief, and skepticism were not necessarily associated with greater opioid consumption or worse pain.

Conclusion

Participants provided insights into the experience of COLP which may help to guide its future utilization to manage acute pain and tapering from opioids.
Appendix
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Metadata
Title
Experiences of Patients Taking Conditioned Open-Label Placebos for Reduction of Postoperative Pain and Opioid Exposure After Spine Surgery
Authors
Valerie Hruschak
K. Mikayla Flowers
Megan Patton
Victoria Merchantz
Emily Schwartz
Robert Edwards
Ted Kaptchuk
James Kang
Michelle Dossett
Kristin Schreiber
Publication date
01-08-2022
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 4/2023
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-022-10114-5

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