717: Better than Expected - Placebo Hypoalgesia in Elderly Persons Despite Lower Treatment Expectations

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Non -specific to any diagnosis, Psychology, Placebo/Nocebo, Pain mechanisms (e.g. descending inhibitory control, placebo, inflammation)

Background and Aims: Pain becomes more likely and prevalent with advancing age, as does the likelihood of receiving pain therapy; yet research on placebo hypoalgesia, which takes into account age effects, remains limited. The few existing studies directly comparing younger and older individuals suggest largely preserved placebo responses in later life [1]; however, the potentially altered underlying mechanisms, as well as possible compensatory processes, have yet to be systematically elucidated.
To this end we employed a placebo cream paradigm comparing younger and older participants and assessed treatment expectancy in addition to indicators of placebo hypoalgesia.

Methods: We investigated 40 elderly (>65 years) and 40 younger (<35 years) participants, who underwent a placebo paradigm consisting of a expectation manipulation followed by a placebo conditioning phase [2]. During conditioning, heat pain stimuli at pain threshold were administered on placebo treated patches of skin, while control patches were stimulated above threshold. During the following test phase, identical pain stimuli were administered on placebo and control areas. In addition to pain ratings (NRS), participants rated the analgesic effectivity of the introduced placebo cream.

Results: Analysis of pain intensity and pain unpleasantness ratings assessed during the test phase revealed significant, large placebo effects in younger and older participants alike, though slightly more pronounced in the younger group. Expectancy ratings were significantly higher after conditioning, indicating successful reinforced expectation induction. However, ratings of analgesic potency were significantly higher in younger compared to older participants.

Conclusions: The present results show in line with previous findings significant placebo hypoalgesia, which became also evident in elderly participants. This demonstrates the relevance and effectiveness of psychological pain modulation across the life span. Given that positive therapeutic expectancy was less pronounced in elderly participants despite strong placebo effects, the questions arise whether elderly persons or even patients might especially benefit from detailed treatment explanation in order to support therapy effects.

References: 1. Wrobel, N., et al., Preserved Capacity for Placebo Analgesia in the Elderly. J Pain, 2016. 17(12): p. 1318-1324.
2. Reicherts, P., et al., Psychological Placebo and Nocebo Effects on Pain Rely on Expectation and Previous Experience. J Pain, 2016. 17(2): p. 203-14.

Presenting Author: Philipp Reicherts
Submitting Author: Philipp Reicherts

Senior Author: Miriam Kunz

IASP 2026 Global Year theme of Neuropathic Pain: No

• Emilie-Luise Lorenz: NA - Department of Medical Psychology and Sociology, University of Augsburg
• Katharina Lembke: NA - Department of Medical Psychology and Sociology, University of Augsburg
• Miriam Kunz: Prof. Dr. - Department of Medical Psychology and Sociology, University of Augsburg