A new study is the first to demonstrate beneficial placebo effect for lower back pain sufferers who knew they were taking 'fake pills.' Patients who knowingly took placebos reported 30 percent less pain and 29 percent reduction in disability compared to control group. 'Open-labeling' addresses longtime ethical dilemma, allowing patients to choose placebo treatments with informed consent-source sciencedaily link
It appears placebo can work even with knowledge of it being placebo, which should generate internal doubt about the validity of treatment. Of course there'd be uncertainty you believe it's fake, but you can never be 100% certain in many cases.
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