The placebo trap

Abstract

Monodisciplinary orthopaedic pain therapy no longer measures up to international standards. In cases of chronic back pain, in particular, there is such a gulf between the clinical findings and the patient's subjective assessment that the symptoms cannot be attributed solely to so-called degenerative changes. Back pain patients are in great danger of becoming fixated on somatic symptoms due to an excess of diagnostic procedures or incorrect diagnoses, of being treated purely somatically on the basis of associated findings, and of suffering irreversible damage from invasive management of such findings. Despite the wealth of empirical evidence, it remains difficult to expand the everyday concept of illness and its causes to include not only physical and biological factors but also social and emotional disturbances. Particularly physicians with a purely biological concept of pain have not learned to take note of affective relational factors and incorporate them into their diagnostic assessment. The decision to undertake invasive diagnostic or therapeutic procedures then frequently represents the doctor's reaction to feelings of irritation or helplessness. If this situation is to change, an interdisciplinary concept of pain must be made a part of medical training, and scientific findings must be presented in such a way that they can be integrated into routine daily practice.