Are Common Interventional Procedures as Effective as Placebos?
So many of us with chronic pain have gone through a revolving door of treatments, understandably hoping the next injection, ablation, or surgery will finally bring relief. But a recent article published in the British Medical Journal reveals a troubling reality: many commonly used interventional procedures for chronic back and neck pain are no better than placebo.
Despite their widespread use, interventions like epidural steroid injections, radiofrequency ablation, and spinal cord stimulators show little long-term benefit. Worse, they come with risks – ranging from infections to nerve damage – without truly addressing the root of pain. So why are they still so common? The medical system often prioritizes quick fixes over lasting solutions, and many practitioners are incentivized to perform procedures rather than explore non-invasive, evidence-based treatments.
Epidural steroid injections may provide short-term relief, but research shows they often fail to produce meaningful long-term results. Similarly, radiofrequency ablation temporarily disrupts nerve signals, but doesn’t resolve the underlying issue. Even spinal surgeries like fusion frequently leave patients with ongoing pain while introducing complications.
Busse JW, et. al. Commonly used interventional procedures for non-cancer chronic spine pain: a clinical practice guideline. BMJ. 2025 Feb 19;388:e079970. doi: 10.1136/bmj-2024-079970. PMID: 39971339.
“… surgery is a powerful placebo, perhaps the ultimate placebo. The effectiveness of a placebo is directly proportional to the impression it makes on the patient’s subconscious mind.” ~ John E. Sarno
Harnessing the Placebo Effect for Good
Keep in mind, although research shows that many of these procedures are often no better than placebo, the placebo effect is not necessarily all negative. We can harness the placebo effect for good. But it is important to weigh the risk of the placebo intervention. A surgery that is no better than sham is invasive and potentially harmful, whereas something like a sugar pill or reinforcing the brain’s healing capacity with pain recovery therapies is a lot less risky.
Instead of focusing solely on structural causes and physical interventions, research now emphasizes the role of the nervous system in chronic pain and a greater need for psychosocial interventions. When pain persists, the brain and nerves often become hypersensitive, amplifying discomfort even when no injury is present. Addressing these pathways through approaches like Pain Reprocessing Therapy (PRT) can help retrain the brain’s response to pain, leading to lasting relief.
Reading
The Brain and Pain: Breakthroughs in Neuroscience by Richard Ambron
In The Brain and Pain, Ambron, professor and former director of a neuroscience lab, explains the science behind how and why we feel pain. He describes how the nervous system and brain process information that leads us to experience pain and how pharmacological agents such as opiates affect the duration and intensity of pain. Ambron examines evidence showing that discrete brain circuits modulate the experience of pain in response to placebo, fear, belief, and anxiety, as well as how pain can be relieved by activating these circuits using mindfulness and other non-invasive, nonpharmacological treatments.
Research
Neurobiological Mechanisms of the Placebo Effect
The placebo effect is a complex psychological phenomenon that highlights the importance of patient expectations and beliefs in therapeutic outcomes. The placebo effect is commonly researched in pain care as it can greatly impact patient recovery. When individuals receive a placebo – an inactive treatment they believe to be effective – their experience of pain may be reduced through neurobiological mechanisms.
Research has revealed that expectation and conditioning underlie the placebo effect, and that it involves specific neurobiological pathways, particularly those associated with endogenous opioids (enkephalins and endorphins).
Placebo analgesia, or pain relief due to placebo “intervention”, can be linked to the brain’s production of endogenous opioids, meaning that the body’s natural pain-relieving systems are activated when a patient expects relief. This effect has been observed in situations where the opioid antagonist, naloxone, blocked the pain-relieving effects of a placebo. Researchers found that placebos can reduce pain in two ways: through opioid mechanisms (which can be blocked by naloxone) or non-opioid mechanisms (which can’t be blocked by naloxone). As it turns out, when strong expectations of pain relief are given, naloxone can block the placebo effect, but when those expectations are lowered, naloxone has no effect.
The study of the placebo effect has controversial clinical and ethical implications because of the use of inactive treatments in clinical trials when effective ones are available. However, research repeatedly demonstrates that placebo effects can mimic those of active interventions, even for treatments that are eventually proven to be effective.
Overall, the placebo effect emphasizes the power of the mind in managing pain, showcasing how psychological factors can elicit real physiological responses that help reduce discomfort and improve overall patient outcomes.
Benedetti F, Mayberg HS, Wager TD, Stohler CS, Zubieta JK. Neurobiological mechanisms of the placebo effect. J Neurosci. 2005 Nov 9;25(45):10390-402. doi: 10.1523/JNEUROSCI.3458-05.2005. PMID: 16280578; PMCID: PMC6725834.