Pain Management

The placebo effect: Amazing and real

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

Many people believe that the placebo effect is solely a psychological phenomenon. But for some people, a placebo can have real, measurable therapeutic benefits. The power of the placebo effect is significant enough that it can actually skew study results. Additional research is needed to better understand how to leverage the placebo effect and when doing so might offer real benefits to patients.

The problem with prescription painkillers

Wynne Armand, MD
Wynne Armand, MD, Contributing Editor

Opioids are effective pain relievers. But sometimes people can develop a tolerance to these drugs, requiring increasingly higher doses of medication to achieve the same pain relief. And physical dependence — withdrawal symptoms when the drug is stopped — is also common. The increased availability of these drugs has put many people at risk for addiction, overdose, and even death.

Is it hard to decide about total knee replacement? Totally!

Robert H. Shmerling, MD
Robert H. Shmerling, MD, Faculty Editor, Harvard Health Publications

If arthritis in your knee means you can’t do everything you want, whether that’s walking the dog or playing a game of tennis, you may be considering a knee replacement. But are the benefits “as advertised”? A study published in The New England Journal of Medicine suggests that they may be, but it’s more important to weigh the risks and benefits with your personal preferences in mind.

Physical therapy as good as surgery and less risky for one type of lower back pain

Howard LeWine, M.D.
Howard LeWine, M.D., Chief Medical Editor, Internet Publishing, Harvard Health Publications

One type of lower back pain, called lumbar spinal stenosis, can be painful and potentially disabling. An operation known as laminectomy or decompression is sometimes done to ease the pain of lumbar spinal stenosis. Physical therapy can also help. Researchers compared the results of laminectomy to those of a special physical therapy program among nearly 170 Pittsburgh-area men and women with lumbar spinal stenosis. The two approaches worked equally well — pain declined and physical function improved. There were more complications in the surgery group. Since there are no hard and fast rules for choosing the right treatment for lumbar spinal stenosis, the results of this study offer some guidance — try a well-designed physical therapy program first.

Report highlights the dangers of opioid painkillers

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Opioid painkillers like hydrocodone and oxycodone offer blessed relief from pain. But the body gets used to them, requiring ever-higher doses. They are also addictive, cause side effects, and can kill. A report in the New England Journal of Medicine says prescription painkiller abuse accounts for about 17,000 deaths a year. Doctors are learning to say no to opioids, but have limited scientific guidance on when and how to best use them for chronic pain. Ideally, these drugs should prescribed for the shortest time possible and, if pain persists, a transition made to a non-addictive form of pain control. This may be other medications or specialized counseling from a pain specialist that might include complementary and alternative treatments, like acupuncture and meditation.

Cold hands: Could it be Raynaud’s?

Patrick J. Skerrett, Former Executive Editor, Harvard Health

If your fingers turn ghostly white and numb when they get cold, you may have Raynaud’s syndrome (or disease or phenomenon). This common condition Raynaud’s is an exaggeration of the body’s normal response to cold. It usually affects fingers and toes, but may also affect the nose, lips, ears, and nipples. Named after the French physician who first described it in 1862, Raynaud’s is a problem in the body’s arteries. They spasm and collapse in response to cold or stress. Without a steady supply of warm blood circulating through them, the affected body part becomes pale. When the spasm ends and the arteries reopen, allowing blood to flow again, the finger, toe, or other body part turns pink or red. It may throb or tingle. Prevention—staying warm—is the best medicine. It’s possible to cut an attack short by running your hands under warm water, putting them in your arm pits, or waving your arms in circles to get the blood flowing. Other options include thermal feedback and relaxation techniques. More experimental options include Botox injections and sildenafil (Viagra).

Acupuncture for knee arthritis fails one test but may still be worth a try

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

A report published this week in the Journal of the American Medical Association offers weak-to-no proof that acupuncture helps ease the pain of knee arthritis. In a group of older men and women with arthritis-related knee pain, Australian researchers compared traditional needle acupuncture against laser acupuncture, sham laser acupuncture, and no treatment. People who had needle or laser acupuncture reported slightly less pain and slightly better physical function compared with the group that had no treatment at all. Sham acupuncture worked as well as real acupuncture, suggesting the placebo effect may be at work.

Acetaminophen may do little for acute back pain

Nancy Ferrari
Nancy Ferrari, Senior editor, Harvard Health

When back pain strikes, all you want is relief—as quickly as possible. Many folks turn to over-the-counter pain relievers to help take the edge off and keep them moving. Acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen, aspirin), are common and reasonable choices. Australian researchers tested how well acetaminophen worked for back pain that comes on suddenly (so-called acute back pain). Not much, it turned out. Among people who took acetaminophen as needed or on a three-times-a-day schedule, it took about 17 days for the pain to go away completely. Among those who took a placebo, it took 16 days. Does this mean that you shouldn’t bother to use acetaminophen for back pain? Not necessarily. But it might be worth trying cold, heat, and light physical activity.

After hip fracture, exercise at home boosts day-to-day function

Daniel Pendick
Daniel Pendick, Former Executive Editor, Harvard Men's Health Watch

Even after intensive rehabilitation therapy, many people who break a hip still can’t do things they used to do with ease, like dressing, rising from a chair, or climbing stairs, after . A report in this week’s Journal of the American Medical Association shows that simple exercises done at home can make a big difference in recovering from a broken hip. A set of “functional exercises” that mimic the kinds of things people normally do in their daily lives improved function and mobility among people who had broken a hip. It’s important :just do it.” At-home rehab is of no use if you don’t stick with it. These kinds of exercises can also help ward off post-fracture complications like blood clots, pneumonia, wound infections, and more. Extended bed rest after a major injury or surgery can feed a downward spiral of physical deconditioning and additional health problems.

Back pain often overdiagnosed and overtreated

Daniel DeNoon
Daniel DeNoon, Executive Editor, Harvard Heart Letter

What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.