By Gwen on Thursday, July 13, 2000 - 12:55 pm:

I posted a long conversation on this topic a couple of days ago but it seems to have got swallowed up, so here goes again. The posting was inspired by a comment of Eppie's which started "Placebo effect my fanny"
Placebos do relieve pain. In controlled clinical trials to test the efficacy of analgesics it is consistently found that at least a third of people in the placebo group report a diminution of their pain symptoms. In other controlled drug trials, for conditions as diverse as angina and diabetes, similar results are recorded.
I won't quote sources here as there are many and can be easily resourced on internet. In the case of pain relief what seems to happen is that the physical act of taking the placebo or being injected with it stimulates the brain to produce endorphins and enkephalins which are the body's natural analgesics. Acupuncture, massage, hypnosis also seem to work in a similar manner.
So when people say that pain is "all in your head" they are quite correct but not in the way they imagine.
As far back as 1965 Melzack and Wall proposed a hypothesis which they called "gate control" They said that there is a "gate" in the spinal cord which can be closed to prevent pain messages travelling from the point of stimulus to the brain. Different things can close this gate including other physical stimuli such as touch which travels to the brain faster than pain and thus arrives and is registered consciously before the pain is, analgesics which chemically interrupt the transmission at the nerve synapses and also descending inhibitory pathways from the brain. These seem to act in a number of ways. Distraction can often lessen the sense of pain as can good feelings (happy people feel less pain than unhappy ones is the theory)The "fight or flight" syndrome is a classic example of descending inhibitory pathways at work. The soldier in battle or the athlete in an important competition who doesn't realise until afterwards that s/he has sustained a serious injury.
The way placebos seem to act is by causing the descending inhibitory controls to come into play. One of the articles I read also suggested that the therapists attitude could also have a placebo effect. If you trust your therapist and they show a genuine interest you are more likely o relax and by relaxing lose some of the 'secondary pain' from muscle tenseness and anxiety/anger. Other articles suggest that placebos should be used as therapeutic tools because they do work and sugar filled capsules and normal saline injections are considerably cheaper than pharmaceuticals. I can see the drug comapnies buying that one!
All of this goes to show what a complicated issue pain is. If you are interested Melzack and Wall wrote a very good book "The Challenge of Pain" which explains different theories.

By MichelleT on Tuesday, July 18, 2000 - 04:44 pm:

That's very interesting Gwen. I do agree, that pain management can often be found through management of one's state of mind. Hey, I don't care if I'm using real meds or not, as long as it works.
Now by acknowledging this, I am in no way diminishing the impact that pain can have on one's life. But wouldn't it be great if we could learn to use non-chemical methods to manage pain.

By Gwen on Tuesday, July 18, 2000 - 10:47 pm:

I think there is a place for every form of therapy in the treatment of chronic pain. My personal philosophy is that, if it works it works. Far too little is known about the mind and how it controls the body to be dogmatic about whether treatment is mainstream or crank. Fifty years ago western medicine would have downcried sticking needles into people's to relieve pain or using hypnosis as a means of analgesia but they are now widely accepted.
Doctors need to take a holistic approach when treating patients. In particular I think more attention needs to be paid the the theory that a happy person feels less pain than an unhappy one. In part I suspect that a person who is generally happier and more contented with life is a more relaxed one. Tense muscles, whether from anxiety/anger or from guarding a painful area causes vaso-constriction and consequent slowing/stopping of blood flow to an area which causes more pain or cramping. More pain causes more distress, more muscle tension etc. Somewhere one has to break this cycle and learn to recognise what situations cause it to reccur.
Some pain is inevitable in life. In fact life without pain would be very short. Pain is Nature's way of warning about a harmful or potentially harmful situation and saying,"Do something about it or you will be injured" Some children are born with no sense of pain and have to be constantly watched. Also some conditions cause people to lose their ability to recognise pain, diabetes and leprosy are two that immediately come to mind.
Pain is only "bad" when it no longer fulfils its use as a warning and becomes chronic. The pain receptors in the central nervous system are interpreting other stimuli such as touch and proprioception as pain because of chemical changes. Again I refer people to Melzack and Wall's book which explains far more thoroughly.