Conditioned open-label placebo for opioid reduction after spine surgery: a randomized controlled trial

Abstract

Placebo effects have traditionally involved concealment or deception. However, recent evidence suggests that placebo effects can also be elicited when prescribed transparently as “open-label placebos” (OLP), and that the pairing of an unconditioned stimulus (e.g., opioid analgesic) with a conditioned stimulus (e.g., placebo pill) can lead to the conditioned stimulus alone reducing pain. In this randomized control trial, we investigated whether combining conditioning with an open-label placebo (COLP) in the immediate postoperative period could reduce daily opioid use and postsurgical pain among patients recovering from spine surgery. Patients were randomized to COLP or treatment as usual (TAU), with both groups receiving unrestricted access to a typical opioid-based postoperative analgesic regimen. The generalized estimating equations method was used to assess the treatment effect of COLP on daily opioid consumption and pain during postoperative period from post-operative day (POD) 1 to POD 17. Patients in the COLP group consumed approximately 30% less daily morphine mg equivalents (MMEs) compared to patients in the TAU group during POD 1-17 (-14.5 daily MME; 95% CI: [-26.8, -2.2]). Daily worst pain scores were also lower in the COLP group (-1.0 point on the 10-point scale; 95% CI: [-2.0, -0.1]), although a significant difference was not detected in average daily pain between the groups (-0.8 point; 95% CI: [-1.7, 0.2]). These findings suggest that COLP may serve as a potential adjuvant analgesic therapy to decrease opioid consumption in the early postoperative period, without increasing pain.