Placebo: No Relief for Ms. Mahoney’s Pain

In Brief OVERVIEW: Is a placebo ever an appropriate therapeutic intervention? This month we examine that question, and others, in a trio of articles on the use of placebos. A case study. A nurse discovers deceptive placebo use in a nursing home. The author describes how he uncovered the practice and what it took to initiate change at the facility. Ethical Issues. An essay from the column’s coordinator considers the nurse’s responsibilities and how deceptive practice affects patient care, as well as the appropriateness of placebo use in clinical practice. Pain Control. Addressing placebos and the treatment of pain, the authors assert that they should be used only in trials approved by an institutional review board. They also make arguments against the American Pain Society’s position on the use of placebos in “N-of-1 trials,” which are purported to “evaluate the effectiveness of a procedure or treatment in a single person.” Over the course of three months, only “obecalp”—“placebo” spelled backward—had been administered to treat this nursing home resident’s pain.