Remedies for headache prescribed by doctors have all passed the test of a placebo trial, carried out in the relatively calm atmosphere of university hospital out-patient departments. The trial reported here was done in a much more unusual setting in 1995 by a group of doctors and scientists from the US National Institutes of Health in Bethesda, Maryland. All of us have had headaches, with which we coped as well as we could. This trial was carried out on 30 patients whose headache disturbed them so much that they had gone to a hospital emergency department. It is important to realize that these patients would have been unusually worried by their headache and would have been full of expectation that powerful medicine would be given. Everyone was given an injection: one-third were given an aspirin-like drug, ketoralac, one-third a narcotic, meperidine, and the other third received a saline injection, all double-blind. All three injections produced an identical reduction of pain. The reason for choosing this example of a placebo effect is to emphasize the effect of the patients’ expectation in exaggerating the placebo effect. The two drugs had normally been tested on relaxed patients and shown to be superior to placebos. In this case, where the patients had deliberately sought emergency treatment and had a high expectation, the placebo was as effective as the drugs. Clearly, we are dealing with a subtle but powerful effect.
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