Open label placebo for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials

To assess the therapeutic potential of Open-Label Placebo (OLP) for chronic low back pain (CLBP). A systematic literature search was conducted on 12 September 2024. Data extraction focused on follow-up and change-from-baseline data of the placebo or control groups. The effect sizes were calculated using the inverse variance statistical method. A meta-analysis of four articles involving 171 OLP patients and 161 controls demonstrated a modest reduction in pain on the numerical rating scale (Mean difference = -0.62; 95% confidence interval: −1.09 to −0.14; <i>p</i> = 0.01; I² = 31%). However, according to GRADE, the certainty of evidence for this finding is very low due to methodological limitations of the included studies and potential biases. These findings, even if small, suggest potential benefits of OLP for pain reduction, with clinical relevance of the effect size being important depending on the clinical context and the patient’s perspective. OLP demonstrated a reduction in pain, with a slightly greater improvement observed during shorter intervention periods. However, the certainty of this evidence remains very low, indicating that these findings should be interpreted cautiously. Future clinical trials are needed to further explore the potential and limitations of this intervention. www.crd.york.ac.uk/prospero identifier is CRD42024568302. Chronic low back pain (CLBP) is a common and challenging condition to manage. Some recent studies have explored whether open-label placebos (OLPs) – placebos taken with full knowledge that they contain no active medicine – can help reduce pain and improve well-being. However, many of these studies have limitations, such as small sample sizes and potential biases, making it difficult to draw strong conclusions. Our review combined data from the available research to understand the potential effects of OLPs on CLBP. The findings suggest that OLPs may slightly reduce pain and improve symptoms like depression and disability. However, the overall certainty of the evidence is very low due to weaknesses in the included studies. While the results are promising, they should be interpreted with caution. More high-quality research is needed to confirm these findings and explore how OLPs might work over the long term. This review is an important step toward better understanding how OLPs could be used to manage chronic pain and improve patients’ lives.