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Physicians have long known that if a patient is assured that he will recover and is treated with sympathy, his pain will often disappear. In the same way, a simple sugar pill, or placebo, prescribed in place of drugs, can have a curative effect. In fact, before the 20th century, when doctors relied on bleedings and all sorts of dubious nostrums, most of medicine was a type of placebo (Latin for "I will please").
Several studies have documented the efficacy of placebos. In 1955, Harvard Researcher Beecher found that sugar pills work one-third of the time in treating conditions ranging from headache and seasickness to wound pain. Levine and Fields of U.C.S.F. have reported that a placebo was capable of mimicking the effect of four to six milligrams of morphine, a mild dose, in patients suffering the pain of tooth extractions. U.C.S.F. researchers have also shown that the placebo effect is partly due to the stimulation of the body's endorphin system. When the action of endorphins is inhibited (by using a powerful opiate-blocking agent), placebos may not work.
Unfortunately, the psychological element in chronic pain has often led physicians to dismiss their patients' complaints. Says Fields: "Many doctors and nurses believe that if a person responds to a placebo, the pain can't be very bad. This is a terrible mistake." Only about 5% of chronic pain patients are hypochondriacs or hysterics, according to Psychiatrist Anthony Bouckoms of Massachusetts General Hospital. "Pain itself is the reason people suffer; it is not psychopathology," he avers. And yet the most frequent question Bouckoms hears from pain patients is: "Tell me, doctor, is it all in my head?"
She thought she had lifted something too heavy for her during the family's move from South Carolina to New York. But months later, the pain was still getting worse. "Oh, Mama, "her two children would say, "try to forget it." She went to two orthopedic surgeons and a rheumatologist. No one could find anything wrong. "If you get out and run, you'll feel so much better," her husband suggested. But she knew she was unable to run. She began to believe she was making up the pain. "You want to hide your face. Everybody gets tired of people being ill. "After two years, convinced that cancer was the only possible explanation, she persuaded a doctor to take a chest X ray. "That's when they found the whopper, "she recalled recently before her death. The pain had been real, and so was the large tumor in her lung.
People with chronic pain often wind up on a medical merry-go-round: psychiatrists tell them that their problem appears to be physical; internists and surgeons tell them they ought to have their head examined. Western doctors, trained to cure acute illness, are often frustrated by patients with vague pain that refuses to go away. So are the families, who quickly tire of hearing complaints. Dejected, guilt-ridden and increasingly isolated, many pain patients eventually seek care outside standard medicine: herbal treatments, chiropractic, faith healing and, too often, quackery. Says Fields of U.C.S.F.: "They fall through the cracks."
Many of these people are now finding their way to multidisciplinary pain clinics, of which there are about 150 around the world. The idea of