Yoga and massage are associated with smaller placebo effects in chronic pain

Author: Margaret Yin1,2,3, Salim A Muhammed1, Yang Wang1,4, Luana Colloca1,4,5
1 Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, Maryland, USA.
2 Gifted & Talented Research Program, Glenelg High School, Glenelg, Maryland, USA.
3 Harvard College, Cambridge, Massachusetts, USA.
4 Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, Maryland, USA.
5 Department of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, Maryland, USA.
Conference/Journal: Eur J Pain
Date published: 2023 Mar 18
Other: Special Notes: doi: 10.1002/ejp.2111. , Word Count: 250

Complementary and Integrative Health Approaches (CIHA), including but not limited to, natural products and Mind and Body Practices (MBPs), are promising non-pharmacological adjuvants to the arsenal of pain management therapeutics. We aim to establish possible relationships between use of CIHA and the capacity of descending pain modulatory system in the form of occurrence and magnitude of placebo effects in a laboratory setting.

This cross-sectional study investigated the relationship between self-reported use of CIHA, pain disability, and experimentally-induced placebo hypoalgesia in chronic pain participants suffering from Temporomandibular Disorders (TMD). In the 361 enrolled TMD participants, placebo hypoalgesia was measured using a well-established paradigm with verbal suggestions and conditioning cues paired with distinct heat painful stimulations. Pain disability was measured with the Graded Chronic Pain Scale, and use of CIHA were recorded with a checklist as part of the medical history.

Use of physically oriented MBPs (e.g., yoga and massage) was associated with reduced placebo effects (F1,2110.44 =23.15, p<0.001, Cohen's d=0.171). Further, linear regressions indicated that greater number of physically oriented MBPs predicted smaller placebo effects (β=-0.17, p=0.002), and less likelihood of being a placebo responder (OR=0.70, p=0.004). Use of psychologically oriented MBPs and natural product were not associated with placebo effects magnitude and responsiveness.

Our findings suggest that use of physically oriented CIHA was associated with experimental placebo effects possibly through an optimized capability to recognize distinct somatosensorial stimulations. Future research is needed to understand the mechanisms underlying placebo-induced pain modulation in CIHA users.

PMID: 36932918 DOI: 10.1002/ejp.2111