A memorable patient: Effective analgesia

BMJ 1997; 315 doi: (Published 29 November 1997) Cite this as: BMJ 1997;315:g
  1. David S H Bell, professor or medicine
  1. Birmingham, Alabama

    I was a house officer, and our medical unit was on take. The senior oncologist admitted a 15 year old boy with terminal Hodgkin's disease. I was told that nothing more could be done and I was simply to “keep him comfortable.” This was in 197l, just before effective treatment for Hodgkin's disease became available.

    As is common among junior doctors, I did not want to overprescribe narcotics, and as a result the patient asked for his intramuscular analgesia more frequently. The nursing staff thought that he really did not need such frequent analgesia and that he was demanding medication when the next dose was available and not when it was needed. I decided to initiate a trial of placebo treatment.

    Ten minutes after the injection of 5 cc of normal saline the patient asked to see me. He was so debilitated and drowsy that I had to sit down by his bedside to get close enough to hear his request. “Doc,” he said, “please give me another shot—the last one was like water.”

    His analgesia was continued at a higher dose. I have never again used placebo medication.

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