Current Concepts | Invited Review
Procedure Suggested clinical applications
Patient’s beliefs and characteristics
1. Select patients based on treatment
Stop prescribing interventions of a type that a patient has previously not responded to (eg, tablets);
instead, prescribe a different, new type of treatment (eg, psychological therapy).
2. Create positive expectancy Tell the patient the intervention is likely to be effective.
Elicit patients’ treatment and illness beliefs and expectations and dispel any misconceptions.
Empower patients to self-care.
3. Reduce negative expectancy Limit emphasis on major potential side effects and describe how uncommon they are.
Hide cessation of analgesia administration (eg, as in Benedetti et al), after obtaining advanced consent and
ensuring patients are aware they can request additional analgesia if needed.
4. Convey a positive therapeutic
message through informed consent
Provide written and/or verbal information that conveys a positive therapeutic message about treatment.
Provide clear rationale for treatment.
Provide patient testimonials and supporting literature/media.
5. Harness sociocultural context Elicit patients’ culturally embedded treatment and illness beliefs, preferences and expectations, dispelling
any potentially harmful misconceptions.
Involve significant others in care.
Practitioner’s beliefs and characteristics
6. Practitioner expectancy Only prescribe a treatment to patients when the practitioner expects it will be effective; communicate that
expectation to patients.
7. Practitioner’s personal
Honour patient preferences for particular practitioners.
Use indicators of expertise/high status in offices, in correspondence and when referring to other
Ensure the patient is seen by a practitioner whose views/values are congruent with the patient’s views/
8. Active recruitment Actively seek out patients and invite them to attend clinic regarding a particular intervention (as opposed
to waiting for patients to present).
9. Active retention Personally contact patients if they miss an appointment.
Use incentives to encourage patients to keep appointments.
10. Follow-up Routinely invite patients to book a follow-up appointment after an intervention has finished and prior to
Encourage the patient to take responsibility for and self-manage their condition following an intervention.
11. Follow a standardised protocol Use patient-friendly treatment protocols and share with patients where they fit in that protocol.
12. Ethical oversight Ensure that patients understand that their treatment protocol is sanctioned by a higher authority, for
example, National Institute for Health and Care Excellence.
13. Participating in research Inform patients that all outcomes and practitioner performance is audited and can contribute to improved
knowledge and treatment for future patients.
14. Symptom monitoring Ask patients to monitor their symptoms regularly, for example using email, phone apps, web-based
systems, paper forms.
Assess treatment outcome.
Give patients feedback on symptom improvements following monitoring.
15. Enhanced environment Ensure that the environment is professional, pleasant and peaceful.
Employ friendly and helpful support staff.
Table. Suggested potential clinical applications of procedures to elicit placebo effects in non-malignant
pain, subject to further research