ONS Position Statement on Placebos in Cancer Pain Management Endorsed by 24 Organizations

The Position Statement on the Use of Placebos for Pain Managementin Patients with Cancer, developed recently by the Oncology NursingSociety (ONS), has been endorsed by 24 nursing and other healthcare organizations.

When the statement was initially published in June 1996, ONS inviteda variety of organizations to endorse it. The position statement was developedto support clinicians and enhance the care of patients with cancer. Between50% to 80% of patients with cancer experience pain that require analgesics.The use of placebos in their treatment is quite common. The Society, however,believes that placebos should not be used in the assessment and managementof cancer pain.

Position Statement Based on Several Issues

The Oncology Nursing Society bases its position statement on severalissues. First, there are many misconceptions about the use of placebos.In particular, some believe that placebos can be used to accurately assesswhether pain is real and to adequately treat pain without harmful sideeffects. Positive response to placebos is often viewed as evidence of malingering,exaggerating, or faking pain. These assumptions are incorrect.

Also, placebos are often used in a punitive sense for patients who haveexhibited manipulative or demanding behaviors or in vulnerable populations,such as those with histories of psychiatric problems or substance abuse.

In addition, the use of placebos necessarily involves deception, whichautomatically raises serious ethical concerns. The use of placebos threatensthe inherent ethical values and norms of health-care professionals as articulatedin the ANA Code for Nurses.

Based on these assumptions, the ONS believes that placebos should notbe used to assess or manage cancer pain, to determine whether the painis "real," or to diagnose psychological symptoms, such as anxietyassociated with pain. The Society asserts that nurses should not administerplacebos in these circumstances even if there is a medical order to doso.

The position statement also includes recommendations to assist health-careproviders with making decisions regarding the use of placebos.

For a complimentary copy of the position statement, contact ONS, 501Holiday Drive, Pittsburgh, PA 15220, or call (412) 921-7373 or FAX (412)921-6565.