Making space for the placebo effect in pain medicine

A broad view of the “placebo effect” incorporating neurobiology, individual psychology, epistemology, history, and culture deeply enriches our understanding of these complex and powerful forces and, indeed, urges us to abandon that narrow and logically inconsistent concept for a much more interesting one. We review some of the data and background for such a contention in a thoroughly interdisciplinary way showing how differently presented, but equally “inert,” treatments (2 placebo tablets versus 4, for example) can have different effects; how the same inert treatment can act differently in different historical times and cultural places; and how crucial is the attitude of the clinician in shaping these intensely meaningful forces. These matters, which typically are left to chance, to ideology, or to market forces, should be embraced by the scientific community. We believe that fundamental insights into human biology remain to be discovered in this area.