Why would placebo be constant? If my thinking is correct, pain is a measured by the WOMAC score which is a self administered questionnaire. So while recipients might receive placebo, they will still report whatever changes in pain they perceive, which would change from trial to trial. Their response to the questionnaire could be impacted by many things including their physical activity, the weather, or the 'placebo effect' itself. This is why statistical significance is important.
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