Placebos in medicine: Pain that is relieved by placebo is not therefore unreal

doi:10.1136/bmj.330.7481.45-c

BMJ 2005;330:45 (1 January), doi:10.1136/bmj.330.7481.45-c

Letter

Placebos in medicine

Pain that is relieved by placebo is not therefore unreal

EDITOR—In his editorial on placebos in medicine Spiegelrightly says that it is not because pain is relieved by placebothat it is not real.¹

I would go one step further. As Professor Raymond Villey, oneof my teachers in Caen, told me almost 30 years ago: "Bewareof the pain that cedes to placebo: it's most certainly organic."

I have seen that proved again and again. I have no explanationother than the one given for the soldiers at Anzio: the patientwith "real" pain wants it to go away so much that any strawwill be clutched at to relieve the pain, including placebo.On the other hand, the patient with "psychological" pain gainsfrom the pain in some manner. There will be much less incentiveto see the pain relieved, and placebo may be as ineffectiveas the other pain treatment.

As for the dose-response to placebo, in clinical trials theadverse reactions to placebos of high dose non-steroidal anti-inflammatorydrugs are much more common than those to placebos of low dosenon-steroidal anti-inflammatory drugs.² Explanations to thefore, please.

Nicholas D Moore, professor of clinical pharmacology

Université Victor Segalen, 33076 Bordeaux, France Nicholas.moore{at}pharmaco.u-bordeaux2.fr

Competing interests: None declared.

References

Spiegel D. Placebos in medicine. BMJ 2004;329: 927-8. (23 October.)[Free Full Text]
Moore N. Diclofenac-K 12.5 mg tablets in mild to moderate pain and fever: a review of pharmacology, clinical efficacy and safety. J Clin Invest (in press).