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April 28, 2022 – Perhaps the most famous expectation effect is the placebo response, in which positive beliefs about a treatment can relieve patients’ symptoms and accelerate recovery. As Thomas Jefferson noted in 1807: “One of the most successful physicians I have ever known has assured me that he used more bread pills, drops of colored water, and powders of hickory ashes, than of all other medicines put together.” Jefferson called this a “pious fraud.”

The benefits of placebos are not just subjective. The brain can release endogenous opioids when we believe that we are receiving an analgesic, resulting in real pain relief. In the past, however, doctors had assumed that some kind of deception was necessary for placebos to work, but recent research is turning this assumption on its head.

Patients with chronic back pain were first offered a presentation on the power of expectation to reduce their symptoms, before being given a jar of clearly labeled placebo pills, to be taken twice a day. Over a few days, their symptoms improved by 30 percent (the threshold for clinical significance). Even more amazingly, they still reported benefits five years later, compared to a group who had continued with the standard treatment. It seemed that the mere knowledge of the expectation effect had continued to help them manage their pain. Given these promising results, many doctors are seriously considering the use of “open-label placebos” as a potential means to stem opioid addiction.

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