How Your Expectations Can Impact Pain Relief

Migraine pain relief seen with both medication and placebos

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Your doctor prescribes pain medication that’s described as very effective. You’re given sets of pills that are labeled either as the brand name or as a placebo (sugar pill). Which do you think works better?

Researchers were surprised to learn that a migraine patient’s expectations played an important role in the pain relief they experienced from an active or inactive medication.

In this study that switched the labeling of the pills, patients reported pain relief after taking placebos that were marked as Maxalt (rizatriptan), a prescription pain reliever. Relief came even from pills labeled as placebo, the scientists discovered.

"Ask your doctor what you can expect from medications you’re prescribed."

Rami Burstein, PhD, director of Pain Research in the Department of Anesthesia, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center (BIDMC), and Ted Kaptchuk, director of the Program in Placebo Studies and Therapeutic Encounter at BIDMC and Harvard Medical School, led this study that looked at the effect a clinician’s positive messages had on the effectiveness of medication.

"One of the many implications of our findings is that when doctors set patients' expectations high, Maxalt [or, potentially, other migraine medications] becomes more effective," Dr. Burstein said in a statement.

This study involved 66 patients who had migraines — throbbing headaches that may be accompanied by nausea, vomiting and light and sound sensitivity.

Participants first described their experience during a “no treatment” migraine episode. They gauged their headache pain and documented symptoms 30 minutes and 2.5 hours after the start of the pain.

The patients were then given packets of pills to use during their next six migraine attacks, which contained a mixture of Maxalt and placebos. The researchers had explained that the medication Maxalt was very effective in relieving migraine pain.

Two of the packets labeled “Maxalt” were made with positive expectations, two were made with neutral expectations and labeled “Maxalt or placebo,” and two were made with negative expectations and labeled “Placebo.” One of the packets in each group (positive, neutral, negative) contained Maxalt and one contained placebos, regardless of the labeling.

Participants reported the effectiveness of the pills taken during each of the next six episodes.

Here’s what the research team uncovered from this experiment:

  • Patients described a 15.4 percent increase in pain during the “no treatment” episode.
  • Pills labeled “placebo” typically reduced pain by 26.1 percent.
  • Pills labeled “Maxalt or placebo” cut pain by 40.1 percent.
  • Pills labeled “Maxalt” lowered pain by 39.5 percent.

“We were surprised that when Maxalt was labeled ‘Maxalt or placebo,’ it had a numerically greater effect on pain (though statistically not significant…) than when it was labeled ‘Maxalt,’ ” the researchers wrote.

Dr. Burstein explained, "When patients received Maxalt labeled as placebo, they were being treated by the medication — but without any positive expectation. This was an attempt to isolate the pharmaceutical effect of Maxalt from any placebo effect. Conversely, the inert placebo labeled as Maxalt was an attempt to isolate the impact of the placebo effect from pharmaceutical effect.”

The authors concluded, "Contrary to conventional wisdom that patients respond to a placebo because they think they're getting an active drug, our findings reinforce the idea that open label placebo treatment may have a therapeutic benefit.”

According to George R. Nissan, DO, member of the medical team at Baylor University Medical Center’s Comprehensive Headache Center, "This study demonstrates the powerful influence of physician communication with migraine patients and their response to a particular medication. It is important for both physicians and patients to understand that setting a positive message about a particular treatment can lead to a better outcome in decreasing migraine pain, which may ultimately lead to improved functionality."

This study was published January 8 in the journal Science Translational Medicine.

The research was supported by Merck and Co. Inc., the maker of Maxalt, National Institutes of Health National Center for Complementary and Alternative Medicine and the Blue Guitar Foundation.

One of the authors disclosed financial ties with Merck and Allergan.

Review Date: 
January 8, 2014
Last Updated:
January 10, 2014