This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Judith A. Turner, PhD; Richard A. Deyo, MD, MPH; John D. Loeser, MD; Michael Von Korff, ScD; Wilbert E. Fordyce, PhD

JAMA. 1994;271(20):1609-1614.

Abstract
Objective.
—To estimate the importance and implications of placebo effects in pain treatment and research from the existing literature, with emphasis on their magnitude and duration, the conditions influencing them, and proposed explanations.

Data Sources.
—English-language articles and books identified through MEDLINE (1980 through 1993) and PsycLIT (1967 through 1993) database searching, bibliography review, and expert consultation.

Study Selection.
—Articles were included if they pertained to the review objectives.

Results.
—Placebo response rates vary greatly and are frequently much higher than the often-cited one third. Placebos have time-effect curves, and peak, cumulative, and carryover effects similar to those of active medications. As with medication, surgery can produce substantial placebo effects, and this possibility is commonly overlooked in case series reports on back surgery. Individuals are not consistent in their placebo responses, and a placebo-responder personality has not been identified. Models advanced to explain placebo effects emphasize the role of anxiety, expectations, and learning.

Conclusions.
—Placebo effects influence patient outcomes after any treatment, including surgery, that the clinician and patient believe is effective. Placebo effects plus disease natural history and regression to the mean can result in high rates of good outcomes, which may be misattributed to specific treatment effects. The true causes of improvements in pain after treatment remain unknown in the absence of independently evaluated randomized controlled trials.

(JAMA. 1994;271:1609-1614)

Author Affiliations
From the Departments of Psychiatry and Behavioral Sciences (Dr Turner), Rehabilitation Medicine (Drs Turner and Fordyce), Medicine (Dr Deyo), Health Services (Dr Deyo), Neurological Surgery (Dr Loeser), and Anesthesiology (Dr Loeser), and the Multidisciplinary Pain Center (Drs Turner and Loeser), University of Washington, Seattle; the Health Services Research and Development Field Program, Veterans Affairs Medical Center, Seattle (Dr Deyo); and the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle (Dr Von Korff).

Footnotes
Reprint requests to the Department of Psychiatry and Behavioral Sciences RP-10, School of Medicine, University of Washington, Seattle, WA 98195 (Dr Turner).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Duloxetine for the Treatment of Recurrent Major Depressive Disorder in Elderly Patients: Treatment Outcomes in Patients With Comorbid Arthritis
Wohlreich et al.
Psychosomatics 2009;50:402-412.
ABSTRACT | FULL TEXT  

Effectiveness of Placebo Therapy for Maintaining Masking in a Clinical Trial of Vergence/Accommodative Therapy
Kulp et al.
IOVS 2009;50:2560-2566.
ABSTRACT | FULL TEXT  

The Anatomy of the Mesolimbic Reward System: A Link between Personality and the Placebo Analgesic Response
Schweinhardt et al.
J. Neurosci. 2009;29:4882-4887.
ABSTRACT | FULL TEXT  

Systematic review of the management of canine osteoarthritis
Sanderson et al.
Vet Rec. 2009;164:418-424.
ABSTRACT | FULL TEXT  

Placebo effects: clinical aspects and neurobiology
Oken
Brain 2008;131:2812-2823.
ABSTRACT | FULL TEXT  

The non-specific effects of group-based cognitive--behavioural treatment of chronic pain
Newton-John and Geddes
Chronic Illness 2008;4:199-208.
ABSTRACT  

Percutaneous Vertebroplasty for Painful Compression Fractures in a Small Cohort of Patients with a Decreased Expectation-Related Placebo Effect due to Dementia
Lehman et al.
Am. J. Neuroradiol. 2008;29:1461-1464.
ABSTRACT | FULL TEXT  

Where dopamine meets opioids: a meta-analysis of the placebo effect in restless legs syndrome treatment studies
Fulda and Wetter
Brain 2008;131:902-917.
ABSTRACT | FULL TEXT  

Clinical trial outcome in neuropathic pain: Relationship to study characteristics
Katz et al.
Neurology 2008;70:263-272.
ABSTRACT | FULL TEXT  

Sacroplasty versus Vertebroplasty: Comparable Clinical Outcomes for the Treatment of Fracture-Related Pain
Whitlow et al.
Am. J. Neuroradiol. 2007;28:1266-1270.
ABSTRACT | FULL TEXT  

A 60-Year-Old Woman Considering Acupuncture for Knee Pain
Berman
JAMA 2007;297:1697-1707.
ABSTRACT | FULL TEXT  

Placebo and Nocebo in Cardiovascular Health: Implications for Healthcare, Research, and the Doctor-Patient Relationship
Olshansky
J Am Coll Cardiol 2007;49:415-421.
ABSTRACT | FULL TEXT  

Improvement in Fibromyalgia Symptoms With Acupuncture: Results of a Randomized Controlled Trial
Martin et al.
Mayo Clin Proc. 2006;81:749-757.
ABSTRACT | FULL TEXT  

The impact of therapy on quality of life and mood in neuropathic pain: what is the effect of pain reduction?
Deshpande et al.
Anesth. Analg. 2006;102:1473-1479.
ABSTRACT | FULL TEXT  

Percutaneous Vertebroplasty: Relationship between Vertebral Body Bone Marrow Edema Pattern on MR Images and Initial Clinical Response
Tanigawa et al.
Radiology 2006;239:195-200.
ABSTRACT | FULL TEXT  

Placebo response in clinical trials of depression and its implications for research on chronic neuropathic pain
Dworkin et al.
Neurology 2005;65:S7-S19.
ABSTRACT | FULL TEXT  

Clinical trials studying pharmacotherapy and psychological treatments alone and together
Haythornthwaite
Neurology 2005;65:S20-S31.
ABSTRACT | FULL TEXT  

Ethical aspects of placebo groups in pain trials: Lessons from psychiatry
Nagasako and Kalauokalani
Neurology 2005;65:S59-S65.
ABSTRACT | FULL TEXT  

What Is Controlled for in Placebo-Controlled Trials?
Fillingim and Price
Mayo Clin Proc. 2005;80:1119-1121.
 

Challenges in Systematic Reviews of Complementary and Alternative Medicine Topics
Shekelle et al.
ANN INTERN MED 2005;142:1042-1047.
ABSTRACT | FULL TEXT  

Efficacy of physiotherapy management of knee joint osteoarthritis: a randomised, double blind, placebo controlled trial
Bennell et al.
Ann Rheum Dis 2005;64:906-912.
ABSTRACT | FULL TEXT  

The Unexpected in Primary Care: A Multicenter Study on the Emergence of Unvoiced Patient Agenda
Peltenburg et al.
Ann Fam Med 2004;2:534-540.
ABSTRACT | FULL TEXT  

Nonpharmacologic Management of Pain
Nadler
JAOA: Journal of the American Osteopathic Association 2004;104:6S-12S.
ABSTRACT | FULL TEXT  

Evidence Report on the Treatment of Pain in Cancer Patients
Carr et al.
J Natl Cancer Inst Monogr 2004;2004:23-31.
ABSTRACT | FULL TEXT  

Patient-reported outcomes better discriminate active treatment from placebo in randomized controlled trials in rheumatoid arthritis
Strand et al.
Rheumatology (Oxford) 2004;43:640-647.
ABSTRACT | FULL TEXT  

Effects of Perceived Treatment on Quality of Life and Medical Outcomes in a Double-blind Placebo Surgery Trial
McRae et al.
Arch Gen Psychiatry 2004;61:412-420.
ABSTRACT | FULL TEXT  

What Now About Acetaminophen?--Reply
Case et al.
Arch Intern Med 2003;163:1863-1863.
FULL TEXT  

Measuring Multiple Dimensions of Religion and Spirituality for Health Research: Conceptual Background and Findings from the 1998 General Social Survey
Idler et al.
Research on Aging 2003;25:327-365.
ABSTRACT  

Nonablative Laser Resurfacing Using the Long-Pulse (1064-nm) Nd:YAG Laser
Dayan et al.
Arch Facial Plast Surg 2003;5:310-315.
ABSTRACT | FULL TEXT  

Context Effects: Powerful Therapies or Methodological Bias?
Di Blasi and Kleijnen
Eval Health Prof 2003;26:166-179.
ABSTRACT  

Breathing retraining for dysfunctional breathing in asthma: a randomised controlled trial
Thomas et al.
Thorax 2003;58:110-115.
ABSTRACT | FULL TEXT  

Placebo Effects in Oncology
Chvetzoff and Tannock
JNCI J Natl Cancer Inst 2003;95:19-29.
ABSTRACT | FULL TEXT  

How the Doctor's Words Affect the Patient's Brain
Benedetti
Eval Health Prof 2002;25:369-386.
ABSTRACT  

The Placebo Effect in Alternative Medicine: Can the Performance of a Healing Ritual Have Clinical Significance?
Kaptchuk
ANN INTERN MED 2002;136:817-825.
ABSTRACT | FULL TEXT  

Effect of pain reduction on postural sway, proprioception, and quadriceps strength in subjects with knee osteoarthritis
Hassan et al.
Ann Rheum Dis 2002;61:422-428.
ABSTRACT | FULL TEXT  

The Effect of an Educational Intervention on Willingness to Receive Therapeutic Touch
Lowry
J Holist Nurs 2002;20:48-60.
ABSTRACT  

A Controlled Study of Minimal-Contact Thermal Biofeedback Treatment in Children With Migraine
Scharff et al.
J Pediatr Psychol 2002;27:109-119.
ABSTRACT | FULL TEXT  

Nonspecific Medication Side Effects and the Nocebo Phenomenon
Barsky et al.
JAMA 2002;287:622-627.
ABSTRACT | FULL TEXT  

Occlusal stabilization appliances: Evidence of their efficacy
KREINER et al.
Journal of the American Dental Association 2001;132:770-777.
ABSTRACT | FULL TEXT  

A Randomized, Double-Blind, Placebo-Controlled Study of Sumatriptan Nasal Spray in the Treatment of Acute Migraine in Adolescents
Winner et al.
Pediatrics 2000;106:989-997.
ABSTRACT | FULL TEXT  

Lack of efficacy of riluzole in the treatment of peripheral neuropathic pain conditions
Galer et al.
Neurology 2000;55:971-975.
ABSTRACT | FULL TEXT  

Percutaneous Neuromodulation Therapy: Does the Location of Electrical Stimulation Effect the Acute Analgesic Response?
White et al.
Anesth. Analg. 2000;91:949-954.
ABSTRACT | FULL TEXT  

Cementing the Evidence: Time for a Randomized Trial of Vertebroplasty
Jarvik and Deyo
Am. J. Neuroradiol. 2000;21:1373-1374.
FULL TEXT  

Placebo-Associated Blood Pressure Response and Adverse Effects in the Treatment of Hypertension: Observations From a Department of Veterans Affairs Cooperative Study
Preston et al.
Arch Intern Med 2000;160:1449-1454.
ABSTRACT | FULL TEXT  

Meta-analysis of benzodiazepine use in the treatment of insomnia
Holbrook et al.
CMAJ 2000;162:225-233.
ABSTRACT | FULL TEXT  

Use of Placebo Surgery in Controlled Trials of a Cellular-Based Therapy for Parkinson's Disease
Freeman et al.
NEJM 1999;341:988-992.
FULL TEXT  

Assessment of Permanent Dual-Chamber Pacing as a Treatment for Drug-Refractory Symptomatic Patients With Obstructive Hypertrophic Cardiomyopathy : A Randomized, Double-Blind, Crossover Study (M-PATHY)
Maron et al.
Circulation 1999;99:2927-2933.
ABSTRACT | FULL TEXT  

Evaluation of Acupuncture for Pain Control After Oral Surgery: A Placebo-Controlled Trial
Lao et al.
Arch Otolaryngol Head Neck Surg 1999;125:567-572.
ABSTRACT | FULL TEXT  

Holistic Pediatrics: A Research Agenda
Kemper et al.
Pediatrics 1999;103:902-909.
ABSTRACT | FULL TEXT  

Multicenter Phase II Study of Capecitabine in Paclitaxel-Refractory Metastatic Breast Cancer
Blum et al.
JCO 1999;17:485-485.
ABSTRACT | FULL TEXT  

Mind-Body Medicine--Fringe or Mainstream?
Madill and Qureshi
JAMA 1998;280:1827-1827.
FULL TEXT  

Symptomatic Treatment of Painful Neuropathy
Low and Dotson
JAMA 1998;280:1863-1864.
FULL TEXT  

Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial
Shlay et al.
JAMA 1998;280:1590-1595.
ABSTRACT | FULL TEXT  

Long-term Effectiveness and Safety of Recombinant Human Interferon Gamma Therapy for Atopic Dermatitis Despite Unchanged Serum IgE Levels
Stevens et al.
Arch Dermatol 1998;134:799-804.
ABSTRACT | FULL TEXT  

Placebo-controlled trials in palliative care: the argument against
Kirkham and Abel
Palliat Med 1997;11:489-492.
 

Placebo-controlled trials in palliative care: the argument for
Hardy
Palliat Med 1997;11:415-418.
 

Intranasal Lidocaine for Treatment of Migraine
Tulchinsky
JAMA 1996;276:1554-1554.
ABSTRACT  

Placebo mania
Rothman
BMJ 1996;313:3a-4.
FULL TEXT  

What Is Adequate and Appropriate Pain Treatment?
Jacobson et al.
JAMA 1996;275:1310-1311.
ABSTRACT  

Anticonvulsant drugs for management of pain: a systematic review
McQuay et al.
BMJ 1995;311:1047-1052.
ABSTRACT | FULL TEXT  

Concept of true and perceived placebo effects
Ernst and Resch
BMJ 1995;311:551-553.
FULL TEXT  

The Importance of Placebo Effects
Ernst and Resch
JAMA 1995;273:283-283.
ABSTRACT  

The Importance of Placebo Effects
Cleophas
JAMA 1995;273:283-283.
ABSTRACT  

A Proposal for Structured Reporting of Randomized Controlled Trials
The Standards of Reporting Trials Group et al.
JAMA 1994;272:1926-1931.
ABSTRACT