Observational studyBMC anesthesiology2026
Understanding and leveraging placebo and nocebo effects in perioperative care: a cross-sectional survey of German-speaking anesthesiologists.
Observational study in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
8 authors.
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Abstract
backgroundPlacebo and nocebo effects, beneficial or adverse responses shaped by patient expectations, modulate perioperative outcomes including pain, opioid requirement, recovery, and complication risk. Although harnessing these mechanisms may improve patient care, their routine use by anesthesiologists remain unexplored. This study systematically assessed anesthesiologists’ knowledge, perceived relevance, and clinical use of placebo and nocebo effects, to identify educational needs and opportunities for enhanced patient care.
methodsAn observational cross-sectional online survey, was conducted in April-May 2024 among German-speaking anesthesiologists, covering diverse clinical settings and career stages. The questionnaire evaluated theoretical knowledge, perceived relevance, clinical application, attitudes toward placebo interventions and feasibility of specific strategies to enhance placebo responses and minimize nocebo effects in clinical practice.
resultsOf 650 respondents (436 complete), self-reported knowledge of placebo effects was moderate (median = 6; 0–10), and lower for nocebo effects (median = 5; p < 0.001). Placebo mechanisms were deemed most clinically relevant in pain management (78%) and palliative care (82%). While 72% considered the use of placebo effects as acceptable and 18% essential, only 35% reported deliberate application of placebo knowledge, and 23% used nocebo mitigation strategies. Contrastingly, 92% routinely employed communication strategies to shape expectations. Placebo utilization included open-label (27%), impure (e.g., subtherapeutic analgesics; 58%), and deceptive placebos (48%).
conclusionAnesthesiologists frequently integrate expectation-based interventions widely, however gaps in theoretical knowledge and deliberate systematic application remain, particularly regarding nocebo effects. Targeted education and evidence-based guidelines may foster ethical, systematic integration of placebo and nocebo effects in perioperative care and improve patient care and safety in anesthesiology.
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