An expert explains the science behind the phenomenon that can help minimize pain and potentially reduce medication use.
Some athletes swear that sticking kinesiology tape on top of aching muscles provides quick pain relief. Others insist foam rolling after a workout enhances their recovery and stops muscle soreness in its tracks.
Despite these convincing anecdotes, there’s a lack of science that backs up these tools’ benefits. There isn't enough evidence to support the use of kinesiology tape for pain relief or improved range of motion after a musculoskeletal injury, according to a 2012 review. And the research investigating foam rolling’s perks isn’t conclusive: A 2019 meta-analysis found that foam rolling had minor, partly negligible effects on recovery and slightly reduced the severity of perceived muscle pain, while a 2020 study on 33 men concluded that the technique seems to be effective for counteracting delayed-onset muscle soreness.
So why do some people seem to experience noteworthy improvements in their condition after using these instruments? The placebo effect could be to blame. In fact, a small 2015 study found that Kinesio Taping was no more effective at reducing chronic lower back pain than a placebo tape.
Here, an expert breaks down what’s happening at a neurological level to create this pain-relief effect — and why it may be worth capitalizing on.
The Placebo Effect, Explained
Essentially, the placebo effect is a neurobiological phenomenon in which the expectation of benefits from a treatment can reduce symptoms, says Luana Colloca, M.D., Ph.D., M.S., a professor of pain and translational symptom science at the University of Maryland.
In the past, placebo effects were often dismissed in research settings, such as the testing of medications, as they were viewed as influencing subjective symptoms — not objective bodily processes. But new evidence suggests that the placebo effect does impact physiological mechanisms and outcomes of pain, according to a review published by Dr. Colloca in Annual Review of Pharmacology and Toxicology.
“For many, many years, we thought that [placebo effect] was merely a bias [such as wanting to please the researcher] related to expectations,” she says. “Today, we know that our brain somehow reacts to the expectation of benefits… and this chain of change in the brain can create a reduction of symptoms. It is not merely perception, but it is really a biological change occurring.”
Specifically, placebos are believed to trigger the release of feel-good neuropeptides, such as opioids, and to modulate brain areas that are involved in the transmission of pain signaling and the formation of expectations, according to the Pharmacology and Toxicology review. Your body’s endocannabinoid, oxytocin, vasopressin, and dopamine systems may also be involved and contribute to pain relief.
The Benefits of Placebos
The placebo effect has historically been considered a nuisance in research trials — even though they lead to symptom improvements — and many painkillers are tossed out during this phase because they don’t perform placebos, per the Pharmacology and Toxicology review.
But in harnessing the power of the placebo effect, some individuals may experience an improvement in pain symptoms without entirely resorting to drugs. “If the person is a placebo responder, you don’t need all of this prescription medication to mitigate pain,” says Dr. Colloca. “You may need less aggressive doses or a multi-therapeutic approach to reduce pain.”
For example, in a 2020 study, participants (who were either healthy, had osteoarthritis, or had fibromyalgia) had an inactive cream applied to their forearm. A placebo group was told that the cream may or may not be a local anesthetic cream, while the control group was told it was inert. After experiencing acute pain from lasers, the placebo group experienced a significant reduction in pain — regardless of whether they were healthy or had a chronic condition. According to the researchers, the results could encourage clinicians to consider alternative treatments and reduce dependence on pain medication that may have unwanted side effects.
How to Trigger the Placebo Effect
You don’t need to trick yourself into experiencing the placebo effect. While it was previously believed that knowing you’re using a placebo treatment negates its benefits, new findings suggest that may not be the case. “Recent research is proving that even when we take a medication and we know that it is a placebo, we may experience an improvement,” adds Dr. Colloca.
In a 2014 study published in Science Translational Medicine, researchers found that a placebo treatment was 50 percent as effective as a migraine drug in minimizing pain — even when participants were told the treatment was a placebo. “The reason why this actually happens is still a matter of investigation,” says Dr. Colloca. “Some people believe that it is a condition of self-control — the fact that you feel in control of the disease — or a trigger of your pharmacological memory… The act of taking medication can produce this memory [of relief] and trigger a similar response.”
The placebo effect may also be triggered with the help of verbal cues and behavioral conditioning, says Dr. Colloca. For instance, when patients are knowingly receiving morphine post-surgery and are told the drug they’re getting is a potent pain treatment, they experience significantly greater benefits than patients who do not know they’re receiving morphine, according to the Pharmacology and Toxicology review. This type of verbal suggestion can lead the individual to anticipate a positive outcome and a placebo effect. Having gone through positive therapeutic experiences in the past also tends to boost placebo-induced pain-relief effects, while negative prior experiences can reduce the effects, per the review.
The ritualistic element of treatment may be at play, too, according to Ted J. Kaptchuk, a professor of medicine at Harvard Medical School and the director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter. "When you look at these studies that compare drugs with placebos, there is the entire environmental and ritual factor at work," Kaptchuk explained to Harvard Health Publishing. "You have to go to a clinic at certain times and be examined by medical professionals in white coats. You receive all kinds of exotic pills and undergo strange procedures. All this can have a profound impact on how the body perceives symptoms because you feel you are getting attention and care."
That said, some individuals don’t respond well to placebos. This may be due to personal healing abilities (some people heal easily while others don’t), as well as behavioral, neurobiological, and sociocultural factors, says Dr. Colloca. For example, people who have a fear of pain may experience less pain relief from placebos, and race can also have an impact: A 2020 study on 372 people found that white participants had larger placebo effects than Black individuals, independent of baseline expectations, pain sensitivity, age, sex, and educational level.
The Bottom Line
The placebo effect may help relieve pain symptoms in some individuals. And there’s potential for healthcare providers to use it ethically with their patients, so long as certain guidelines are followed and they’re able to make informed decisions, according to an article published in the journal International Review of Neurobiology.
That said, additional research is needed to understand how the placebo effect works on symptoms other than pain. And regardless of the use case, placebos should be one component of your treatment program — not the treatment program. “We can use placebo effects to augment the improvement of a therapy but not to [replace] the therapy,” says Dr. Colloca.