Placebo and Pain Chapter 27. Placebo and Nocebo: Ethical Challenges and Solutions

The defining circumstances and reasons for promoting healing processes based on placebo and avoiding (undesirable) nocebo effects in clinical practice represent a challenge for translational and patient-oriented medicine. Exploiting placebos and placebo effects for the benefit of the patient requires a rigorous evaluation of potential benefits and harms associated with these interventions. Moreover, any attempts to harness placebo benefits and mitigate nocebo effects in clinical practice should be done consistently with professional norms and integrity, and ethical-legal requirements of informed consent. This chapter systematically discusses the complex issue of professional and ethical requirements in using placebos and placebo effects in pain-related research and practices. Within this scope, some important questions need to be addressed as well: (a) Can placebo analgesic effects produce clinically significant benefits? (b) What translational research is being done, or should be done? (c) What work is being done in this area to enable and encourage doctors to incorporate ethically the concept of placebo and nocebo effects into their work?