Understanding and leveraging placebo and nocebo effects in perioperative care: a cross-sectional survey of German-speaking anesthesiologists.

BACKGROUND

Placebo 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.

METHODS

An 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.

RESULTS

Of 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%).

CONCLUSION

Anesthesiologists 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.