A placebo is a fake treatment that can produce the effect of real treatment. For eg, a placebo medicine can be a flour or sugar pill. A placebo procedure such as injection or surgery, can involve needle insertion or cutting open but not performing the actual procedure/ surgery. These are sometimes used in research to compare to actual treatments to see if the actual treatment (be it medicine, injection, procedure or surgery) are beneficial on their own.

How does placebo provide relief?

Pain relief with placebo has been associated with beliefs and expectations (from verbal suggestions by doctors, providers, or trusted friends/ family, colleagues). Infact, even when it is revealed that it is a placebo and not real treatment, it still works. It has even been floated as a possible treatment for back pain

Watching others get relief from real treatment (social or observational learning) can get the same amount of relief with placebo.

Anxiety can aggravate pain. A placebo, and the belief that it can reduce pain, can decrease anxiety, thereby decreasing pain.

If repeated pain injections were felt to cause relief, and then followed by a placebo injection, then the placebo injection can cause the same amount of relief. This is conditioning.

It is thought that pill-taking, including bodily sensations such as twisting bottle tops and swallowing, or being in an operating or procedure room can produce associations of pain relief.

It is also possible that spontaneous fluctuations in pain might be interpreted as evidence that the placebo is working, thereby strengthening expectations of relief and setting in motion a benign cycle between expectancy and changes.

One is not better than the other :

Placebo vs spinal injection with local anesthetic (diagnostic block)

Placebo vs Vertebroplasty (injecting cement into a collapsed vertebral fracture)

Over the counter medicines such as ibuprofen, naproxen have been shown to be better than placebo though acetaminophen (tylenol) is not.

No placebo studies have been done against back pain surgeries

References:

Bingel U, Colloca L, Vase L. Mechanisms and clinical implications of the placebo effect: is there a potential for the elderly? A mini-review. Gerontology. 2011;57(4):354–363. doi:10.1159/000322090. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130981/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6749916/ Finniss D, Nicholas M, Brooker C, Cousins M, Benedetti F. Magnitude, response, and psychological determinants of placebo effects in chronic low-back pain: a randomised, double-blinded, controlled trial. Pain Rep. 2019;4(3):e744. Published 2019 Jun 7. doi:10.1097/PR9.0000000000000744

https://academic.oup.com/painmedicine/article/18/4/736/2924731; Adriaan Louw, Ina Diener, César Fernández-de-las-Peñas, Emilio J. Puentedura, Sham Surgery in Orthopedics: A Systematic Review of the Literature, Pain Medicine, Volume 18, Issue 4, April 2017, Pages 736–750, https://doi.org/10.1093/pm/pnw164

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