Open-label Placebos May Reduce Kids Pain From Irritable Bowel Syndrome

For kids who suffer from irritable bowel syndrome (IBS), which impacts the large intestine and colon, leading to symptoms like abdominal pain, cramping, bloating, diarrhea, and/or constipation, taking a placebo can help reduce their pain, according to a study published in JAMA Pediatrics in April of 2022.

Research has found that pain is a primary symptom of IBS, so there may be a connection between the gut and the brain. This may be why people with IBS tend to respond to placebos for their pain relief– these fake pills have a psychological effect and make patients feel less pain. Most of the time, however, the placebo is given to patients who are under the impression that they are receiving real medicine.

“Knowing that the placebo effect is such an important force in relieving symptoms for those with IBS, Dr. Samuel Nurko of Boston Children’s Hospital conducted a study to test what would happen if we told family members (and their children) that they were taking a placebo.”

In the study, Dr. Nurko and colleagues examined 30 children (average age 14) with functional abdominal pain or IBS who took sugar pills twice a day for three weeks as a placebo and three weeks as a control. As needed, Hyoscyamine (a medication used to relieve gastrointestinal pain) was permitted as a rescue medication for quick, short-term relief.

The participants reported less pain when they were taking the openly prescribed placebos – that is, fake pills that were openly prescribed, so the patients knew they were not getting the real medication. During the open-label placebo phase, mean pain scores were lower at 39.9 than they were in the control phase at 45.

A total of 14 study participants (46%) reported that their overall wellbeing improved during the open-label placebo period, but nine study participants (30%) said they felt better during the control period. Although researchers noted that this difference was not significant, it contributes to an argument that placebos may have a beneficial effect.

Moreover, 21 of 30 participants (70% reported higher pain scores during the open-label placebo period compared with the control period. During the control period, participants took nearly twice as many hyoscyamine tablets – 3.8 tablets on average, compared with two pills during the open-label placebo period.

Less Medication Means Fewer Potential Health Issues.

According to Shikib Mostamand, MD, a pediatric gastroenterologist at Stanford Children’s Health in Palo Alto, California, who was not involved in the study, hyoscyamine tablets have side effects whereas placebos have none.

“The anti-spasmodic that was used in the study is known to cause undesirable side effects such as constipation,” as Dr. Mostamand mentioned. “Sometimes the very treatments used to alleviate a symptom can actually worsen the underlying problem. Because of this, providers try not to use rescue therapies and treatments as long-term Band-Aids.”

This study showed that there was no difference in bowel movement habits between the open-label placebo period and the control period, meaning that the improvements can be attributed to changes in pain modulation.

As for any limitations of the research, Mostamand noted that the study population was only 30 participants and more expansive research would be needed to back up these preliminary results.

“For scientific data to be effective and create a real difference, it needs to be easily reproduced,” He added. “More multicenter studies are needed to support this initial paper.”

Even though placebo treatments of this type are not included in standard medical care, Mostamand still sees potential.

It’s clear there was no solid evidence to support this approach prior to this paper, he said. “A surprise is that, despite an open-label placebo, in which patients and their parents know that this is a placebo, patients exhibited significant improvements in pain scores.”

The findings are promising, But Nurko says that additional research is needed to understand the mechanisms behind the high placebo response rate in children.

Results indicate that open-label placebos can be used ethically to harness the placebo effect as a therapeutic tool in the clinic; they also offer the added benefit of being inexpensive, easy-to-administer, and safe.

“We found that placebos can affect the brain and the gut, so this means that we can use this treatment to modify pain,” he said. “It seems that believing something will happen can change the way your brain works.”

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