The Role of the Placebo Effect in Mindfulness-Based Pain Relief

THE 2nd OFFICIAL SIPS CONFERENCE ON PLACEBO STUDIESfeatured a study that caught my attention. This Australian study, which is not available online, is entitled "The role of placebo effects in mindfulness-based analgesia" and its details are as follows:

Aim of the study: Mindfulness (awareness meditation) can reduce pain in both experimental and clinical settings, but it is not known how much mindfulness-specific effects and placebo-like expectancy effects account for these positive effects. The aims of this study were: 1. placebo effects to determine whether they contribute to mindfulness-mediated analgesia (pain relief); and 2. to identify the cognitive mechanisms responsible for mindfulness-mediated analgesia versus placebo.

Methods: We compared the effects of focused-attention mindfulness training (6 x 20 dk), sham (fake) mindfulness and no treatment (giving no treatment) on experimental heat pain in a double-blind randomized controlled study. The sham mindfulness instructions lacked the "active ingredients" of the real training but were matched for all other contextual factors.

Findings: Both real and mindful awareness training provided greater pain tolerance than no treatment, but there was no difference between real and sham training. This was accompanied by increased expectancy, belief and pain-related cognitive processes in the two mindfulness groups compared with treatment, but again there was no difference between real and sham training on these outcomes. There was no effect on pain intensity, how it felt, or its threshold.

Conclusion: These findings suggest that mindfulness training - at least training involving focused attention - may increase pain tolerance through a placebo effect rather than any specific attention-related mechanism. Potential mediators of these effects should be discussed.

I find this study noteworthy in two respects:

1. With some imagination, skill and willpower, body / mind therapies even in clinical trials of these therapies, sham procedures can be designed and used.
2. Its results prove that, if placebo effects are controlled for, these treatments may be no more than a placebo therapy.

What implications could this have for clinical practice?

Mindfulness therapies are currently very popular. However, it would not be surprising if the news that their effect may rely entirely on placebo dampened enthusiasm for this treatment. Many people may ask: does it matter, as long as patients benefit, even if the mechanism of action is unimportant?

Important to Know...

The text above traditional, complementary and alternative therapies, a leading figure worldwide in this field, Prof. Dr. Edzard Enrsthas been translated from his blog post.

Mindfulness means noticing what is happening within and around you in the present moment as closely as possible to how it actually is, moment by moment. It means seeing the thoughts passing through your mind, perceiving the emotions you experience and the sensations in your body as they are, and being able to remain with them without reacting, because you are not labeling or judging what is happening as you normally do.