ORIGINAL RESEARCH article

Front. Psychol.

Sec. Psychology for Clinical Settings

Volume 16 - 2025 | doi: 10.3389/fpsyg.2025.1522634

This article is part of the Research TopicOptimizing the Therapeutic Potential in Clinical Settings: Leveraging Placebos and Mitigating Nocebo EffectsView all 8 articles

From catastrophizing to catalyzing: Does pain catastrophizing modulate the beneficial impact of open-label placebos for chronic low back pain? A secondary analysis

Provisionally accepted
Elif Buse CaliskanElif Buse Caliskan1Katharina SchmidtKatharina Schmidt2,3Andreas HellmannAndreas Hellmann2,3Tamás SpisákTamás Spisák2Ulrike BingelUlrike Bingel2,3Julian Kleine-BorgmannJulian Kleine-Borgmann2,3*
  • 1Department of Anesthesiology, University Medicine Essen, Essen, Germany
  • 2Center for Translational Neuro- and Behavioral Sciences, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
  • 3Department of Neurology, University Medicine Essen, Essen, Germany

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Chronic back pain (CBP) is a global health problem with significant health and economic consequences. Traditional analgesics are often no better than placebo, highlighting the need for biopsychosocial approaches. Open-label placebos (OLPs), administered with patient consent, offer a promising alternative. Existing research has mainly focused on the effects of OLP treatments on patient-reported outcomes. In a previous randomized controlled trial (RCT), we investigated whether an OLP treatment improves subjective and objective outcomes such as spinal mobility in CBP patients. The analysis showed significant reductions in pain intensity, disability, and depressive symptoms after OLP combined with treatment-asusual (TAU). However, objective improvements in spinal mobility were not observed. In this exploratory analysis, we aimed to identify predictors of objective improvement after OLP treatment. Psychological factors (e.g., depression, stress, and pain catastrophizing) and baseline physiological measures were analyzed using generalized linear models. Results showed that patients with lower pain catastrophizing exhibited increased spinal motion velocity in the OLP+TAU group, while those with higher pain catastrophizing did not. These findings suggest that OLP treatment may provide measurable benefits for a specific subset of patients, supporting its potential as a personalized intervention in managing CBP. Further research is needed to confirm these findings and to elucidate the role of psychological factors in chronic pain management.

Keywords: Back Pain, Placebos, Placebo Effect, Catastrophization, treatment outcome

Received: 04 Nov 2024; Accepted: 15 May 2025.

Copyright: © 2025 Caliskan, Schmidt, Hellmann, Spisák, Bingel and Kleine-Borgmann. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Julian Kleine-Borgmann, Department of Neurology, University Medicine Essen, Essen, Germany

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