Thursday, March 10, 2011

Perceiving Pain

In response to my blog on the anti-placebo effect (as I called it), a friend sent a link to a recent report on how our expectation (positive or negative) affects our perception.

 An experiment using specific drugs to alter pain levels showed that people's perception of pain changed according to what they were given to believe. The interesting aspect here was that the doctors took into account 'negative expectation' or the fact that patients (especially those with chronic problems) may develop a negative conditioning which prevents them from responding to specific drugs.

I experienced some form of 'positive conditioning' recently when I visited my dentist.  I had to get a difficult filling done and he had said he would be giving me an injection for it.  So I went in, expecting no pain except for a needle prick.  But once he actually looked at the tooth, he seemed to change his mind and went straight ahead and drilled into it.  The procedure lasted for just a few minutes and, while I wasn't comfortable, I didn't feel traumatized or particularly disturbed.  Of course, this was not just because I had gone in feeling comfortable, but because of the faith I have in my dentist, developed painstakingly over decades.

I know that he is swift, sure, alert and extremely competent.  He avoids unnecessary intervention and excess medication.  He has a good idea of my pain threshold.  All these facts came together to provide a cover of reassurance while I was sitting in that chair with my jaws prised open.

And so I feel that one's response to the medicine depends not just on what one is told about it, but also on who is doing the talking. Apart from this, people are more likely to be open to taking medicines if they know that doctors are willing to listen to them should any side reactions occur, and more importantly, to modulate the treatment if it is causing sufficient discomfort.  This process can only work optimally if both the doctor and the patient are reasonable and balanced in their views.  Doctors are what they are, we can only do our best to select one who best suits our needs, but as patients, we can certainly alter our conditioning (especially negative conditioning) to a great extent to help ourselves- but that's another story!

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