Controlling Pain: Placebos: No place in pain management
Paul Arnstein PhD, RN
Kathleen Broglio ANP-BC, ACHPN, CPE
Elsa Wuhrman MS, FNP, ACNP-BC

January 2011 
Volume 41  Number 1
Pages 66 - 67
  PDF Version Available!

A PLACEBO IS ANY SHAM medication or procedure designed to be void of any known therapeutic value based on its physical or chemical properties.1 Placebos may be used in an approved clinical trial in which participants are aware of the possibility of receiving a placebo.2,3 But using placebos for pain management is substandard care that violates the patient's rights to proper assessment and adequate treatment, and puts healthcare providers and facilities at legal risk. Does your facility have policies and procedures in place to ensure that placebos aren't used inappropriately?For nearly 20 years, position statements issued by professional organizations, federal practice guidelines, state boards of nursing, and civil courts have denounced use of placebos in clinical practice, except in approved research trials.4-9 Nevertheless, a shocking number of healthcare providers regularly treats pain with placebos.10 Even more alarming is that some medical students are still being taught that prescribing and administering placebos is clinically appropriate.11Prescribers may justify giving a placebo with the fact that some people experience a desirable placebo effect after receiving a treatment with no known therapeutic value for a given complaint. But some people who are given an inert treatment (such as 0.9% sodium chloride solution) and told it's a drug have undesirable or harmful responses, known as the nocebo effect. These can range from mild discomforts such as nausea and pruritus, to life-threatening complications.12 There's no reliable way to predict which patients will or won't achieve the desired benefit.Some clinicians believe that giving a placebo is an appropriate way to assess pain. But placebos aren't a valid or reliable way to support or refute a patient's report of pain or to assess pain intensity. When patients are alert and oriented and understand the scale being used to assess their pain, their subjective self-report of pain is a more reliable measure of their

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