Treating Pain With Open-Label Placebos: A Qualitative Study With Post-Surgical Pain Patients

Metaphorical perceptions of stoma patients about living with a stoma: A qualitative study

PURPOSE

The purpose of this study was to investigate how stoma patients perceive their experiences living with a stoma.

METHODS

The research is a descriptive study conducted with 42 patients who lived with a stoma for at least 3 months. Data were collected by a face-to-face interview method with a semi-structured form. The metaphors obtained from the analysis are presented under 3 main headings.

RESULTS

The participant's gender was 59.5% male, 78.6% were between the ages of 18 and 64, and 78.6% were married. We discussed patients' statements about living with a stoma under the themes of 'positive', 'negative', and 'both positive and negative'. A statistically significant relationship was found between age groups, stoma type (colostomy/ileostomy), and stoma type (permanent/temporary) (p < 0.05).

CONCLUSIONS

The findings reveal that negative metaphors occur most frequently in patients between the ages of 18 and 64 who have undergone temporary stoma surgery. Knowing patients' perceptions of their stoma can be a guide in planning support services for individuals to cope with their negative emotions.

A qualitative study of imaginary pills and open-label placebos in test anxiety

BACKGROUND

The efficacy of open-label placebos (OLPs) has been increasingly demonstrated and their use holds promise for applications compatible with basic ethical principles. Taking this concept one step further an imaginary pill (IP) intervention without the use of a physical pill was developed and tested in a randomized controlled trial (RCT). To explore participants' experiences and views, we conducted the first qualitative study in the field of IPs.

METHODS

A reflexive thematic analysis (RTA) of semi-structured interviews with test anxious students (N = 20) was nested in an RCT investigating an IP and OLP intervention. In addition, open-ended questions from the RCT were evaluated (N = 114) to corroborate the RTA and pill characteristics were included to more accurately capture the IP experience.

RESULTS

Four key themes were identified: (1) attitude towards the intervention, (2) applicability of the intervention, (3) experience of effects, and (4) characteristics of the imagination. The IP intervention was well-accepted, easily applicable, and various effects, pill characteristics and appearances were described. While many participants did not desire a physical pill, either due to the absence of the imagination component or aversion to pills, the approach was considered to be cognitively and time demanding, which in turn, however, encouraged the establishment of a therapeutic ritual that protected against the increase in test anxiety during the preparation phase. OLP findings were comparable, and especially the importance of a treatment rationale was stressed in both groups, counteracting an initial ambivalent attitude. The RTA findings were supported by the open-ended questions of the RCT.

CONCLUSION

IPs appear to be a well-accepted and easily applicable intervention producing a variety of beneficial effects. Thus, the IP approach might serve as an imaginary based alternative to OLPs warranting further investigations on its application to harness placebo effects without a physical pill.

How orthopedic surgeons view open label placebo pills: Ethical and effective, but opposed to personal use

OBJECTIVE

To examine attitudes of Open Label Placebos (OLP) among a national sample of US orthopedic surgeons.

METHODS

Orthopedic surgeons across the US were invited to participate in a brief online cross-sectional survey; n = 687 participated. The survey included a short vignette of a surgeon using adjunctive OLPs in addition to opioids for postoperative pain management. Participants indicated how ethical and effective they thought OLPs would be in this context, and whether they would personally consider using OLPs.

RESULTS

Nearly three-quarters (73.9%) of the surgeons considered OLPs ethical. In total, 55.4% and 48.8% of participants said that OLPs would "probably" or "definitely" be effective for Vicodin reduction and pain relief, respectively. However, only 19.2% of participants indicated they were personally willing to consider OLPs, and 59.6% were unwilling to do so.

CONCLUSIONS

Generally, orthopedic surgeons perceive OLPs as both ethical and effective, but would not consider using them in their practice. Further research is needed to identify clinician barriers to OLP use.