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A Placebo Treatment for Pain – The New York Times

2016-01-12

Placebo effects are getting stronger in the United States, for example, though not elsewhere. Researchers reported last year that in trials published in 1996, drugs for chronic pain produced on average 27 percent more pain relief than placebos. By 2013, that advantage had slipped to just 9 percent. Likely explanations include a growing cultural belief in the effectiveness of painkillers — a result of direct-to-consumer advertising (illegal in most other countries) and perhaps the fact that so many Americans have taken these drugs in the past.

via A Placebo Treatment for Pain – The New York Times.

This is an opinion piece that plumps the value of placebos and warns that opioids have caused thousands of overdose deaths (see also our post on overdose deaths and the dramatic increases recently.)

The statistics are interesting, even impressive; for example, 44 percent of those receiving sham acupuncture had “adequate” relief of symptoms.  Even more provocative, if the person who performed the acupuncture was especially “supportive and empathetic”, 62 percent of patients had adequate relief.

There is, however, a significant percentage (almost half, in most studies) of patients who do not receive relief unless they are treated with the “real thing.”  Even more distressing is the percentage of patients who do not get relief from any medicine given: perhaps a quarter of those treated are not helped.

Some of those who do not get relief from drug treatment are candidates for surgery, but another group are unable to get relief and do not have a “surgical lesion” (that is, there is no clear reason for operating.)  These patients are the most distressed and the most at risk for drug abuse and overdose.

Some of these patients will chase their pain with higher and higher doses of painkillers or even heroin, and only find relief when they are unconscious or near death.  These are the patients most in need of “supportive and empathetic” treatment, a real connection with another person who will listen to them and not abandon them.

This is the most stressful and most crucial task in medicine: to connect with someone and accept the fact that they have untreatable physical and psychic pain.

There is a scene in the Japanese movie “Redbeard” in which a young intern (circa 1868) is given an assignment by an experienced doctor: sit with a dying patient and just watch him die.

The intern wants to rebel and run away, but he finally accepts his role with this suffering man: just to sit there and watch him die.  Sometimes we have to accept our suffering because there is nothing we can do about it.

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