The discordance between pain and structural changes in osteoarthritis has been recognised for over two decades. Recent research has also identified different pain phenotypes in people with osteoarthritis. This suggests that the changes in the peripheral and central nervous system may affect both the severity and character of pain and associated features in osteoarthritis. Placebo response, the improvement in symptoms in those in the placebo arm of a randomized controlled trial, and placebo effect, the difference in improvement in those treated with placebo (in placebo arm of a randomized controlled trial) and those who have had no treatment (e.g. in the observation only arm of a three arm randomized controlled trial) are mediated by complex neural mechanisms and are especially relevant to the management of osteoarthritis. Indeed, the placebo response associated with most osteoarthritis treatments is stronger than their treatment effects. While a large placebo response is a significant obstacle to the development of new drugs and non-drug interventions for the treatment of osteoarthritis, it can be utilised as a “friend” in the day to day and long-term management of a person with osteoarthritis. This lecture will outline the pain phenotypes associated with osteoarthritis and describe the potential for placebo effect in improving osteoarthritis pain. The pain phenotypes associated with osteoarthritis that are most likely to be improved by optimizing placebo response and the underlying mechanisms will be discussed.
Disclosure of Interest None declared