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This statement may seem curious, or downright nonsensical. But, the meaning of this statement depends upon a full recognition of what placebo is. People often think of placebo as a thing — something like a sugar pill. Indeed, it is quite common to see reference to “administering a placebo” or “taking a placebo.” But, this use of the term obscures important features of placebo, even to the point of losing some essential meaning. It is better to think of placebo in terms of a “placebo effect” — that is, producing a treatment effect by nontherapeutic means. In this way, placebo is not a thing, but rather a process. It is not that the sugar pill makes you feel better, but rather it is all the relevant experiences related to your ailment and the (purported) treatment that leads to a placebo effect (or not). A major component that drives a placebo effect is expectation. The old bromide, “If you think it will work, it will work,” is not completely true, but it is not completely false, either. The converse of this idea (largely only documented anecdotally) is that expecting a real treatment to not work can counteract its true effectiveness. The part that makes placebo real, especially in the context of pain relief, is that if indeed a nontherapeutic intervention does reduce pain, it is a real effect. Another testament to its “reality” are functional neuroimaging studies of brain activity when a successful placebo effect has reduced a person’s pain experience. Specific brain regions, recognized as having the capacity to blunt signals that represent a person’s experience of pain, are activated in conditions in which a successful analgesic placebo has been achieved. So a practical consideration derived from these observations is that gearing up your expectations for a positive analgesic effect will give you a better likelihood of a positive outcome than expecting no effect.

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