Negative experiences can stop painkillers working

http://www.bbc.co.uk/news/health-12480310

"A patient's belief that a drug will not work can become a self fulfilling prophecy, according to researchers.

They showed the benefits of painkillers could be boosted or completely wiped out by manipulating expectations."

Okay, a small trial, and as they say, it wouldn't necessarily apply to chronic patients in the same way, but the point is that the person's mind and expectations played a stronger role than the actual drug. Surely that merits further investigation? As Professor George Lewith points out, randomised controlled trials (RCTs) don't take expectation into account.

When people talk about something being 'all in the mind', that tends to be a way of explaining something away. However, when you say that the expectation of positive treatment activated the cingulo-frontal and sub-cortical areas of the brain, whereas negative expectation 'led to increased activity in the hippocampus and medial frontal cortex' (MFC), that gives it a solid physical basis and provides a starting point for explaining the mechanism of a real, physical effect.