Each of the aforementioned methods may be of value in the context of a comprehensive pain management program, usually conducted in a pain clinic as a means of providing relief from pain and suffering, reducing anxiety, and diverting the patient’s attention, even if only temporarily, from the painful body part. Attempts to quantify the benefits of these techniques—judged usually by a reduction of drug dosage—have given mixed or negative results. Nevertheless, it is unwise for physicians to dismiss these methods, as well-motivated and apparently psychologically stable persons have reported improvement with one or another of these methods and in the final analysis, this is what really matters. Conventional psychotherapy in combination with the use of medication and, at times, electroconvulsive therapy can be of benefit in the treatment of associated depressive symptoms, as discussed above (under “Pain in Association with Psychiatric Diseases”) but it should not otherwise be expected to change the experience of pain.
Similarly, the role of placebo in all branches of medicine is being explored, nowhere more saliently than for pain. Kaptchuk and Miller have indicated in their review that the placebo effect rests upon the qualities of the therapeutic encounter but appears to work through conventional neurobiological mechanisms including endogenous opioids as found by Fields and Levine. Their review gives persuasive examples of placebo effects in migraine and other painful neurologic conditions.
Whatever treatment is undertaken, medical, procedural or surgical, the objective should be to allow and encourage increased use and mobilization of the affected limb or part, as success at this is most closely associated with relief of pain and reduced suffering.
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