Don’t be surprised if you heard your doctor prescribing sugar pills to relieve your certain chronic pains, and don’t be surprised even further if the pills reduced your pain as effectively as any powerful drug on the market would do. Northwestern Medicine scientists have shown that they can reliably predict which chronic pain patients will respond to a sugar placebo pill based on the patients’ brain anatomy and psychological characteristics. “Their brain is already tuned to respond,” said leading researcher A.V. Apkarian, professor of physiology at Northwestern University Feinberg School of Medicine. “They have the appropriate psychology and biology that puts them in a cognitive state that as soon as you say, ‘this may make your pain better,’ their pain gets better.” There’s no need to fool the patient, Apkarian said. “You can tell them, ‘I’m giving you a drug that has no physiological effect but your brain will respond to it,” he said. “You don’t need to hide it. There is a biology behind the placebo response.” This study was conducted on about 60 chronic back pain patients, who were randomized into two groups: subjects who came to the clinic but didn’t get a placebo or drug (control group) and subjects who didn’t know if they got the drug or the placebo. The individuals whose pain decreased as a result of the sugar pill had a similar brain anatomy and psychological traits. The right side of their emotional brain was larger than the left, and they had a larger cortical sensory area than people who were not responsive to the placebo. The chronic pain placebo responders also were emotionally self-aware, sensitive to painful situations and mindful of their environment.

There are three main potential benefits of the findings of this research:

1. Being able to prescribe non-active drugs rather than active drugs: “It’s much better to give someone a non-active drug rather than an active drug and get the same result,” Apkarian said. “Most pharmacological treatments have long-term adverse effects or addictive properties. Placebo becomes as good an option for treatment as any drug we have on the market.”

2. Eliminating the placebo effect from drug trials: “Drug trials would need to recruit fewer people, and identifying the physiological effects would be much easier,” Apkarian said. “You’ve taken away a big component of noise in the study.”

3. Reducing the cost of healthcare: “A sugar pill prescription for chronic pain patients would result in vast cost savings for patients and the health care system, ” Apkarian said.

“Clinicians who are treating chronic pain patients should seriously consider that some will get as good a response to a sugar pill as any other drug,” Apkarian said. “They should use it and see the outcome. This opens up a whole new field.”

To find out more about the details of this research, please refer to Nature Communications, 2018.

“ Sugar pills may reduce your pain as effectively as any powerful drug on the market would do, and the placebo benefits can be predicted by brain anatomy and psychological traits.”