Tom alerted me to this fantastic brief case published in the British Medical Journal where a builder is admitted to hospital in great pain after a nail penetrated all the way through his boot. But it turned out that the pain was entirely psychological, as the nail had missed his foot by sliding between his toes.
A builder aged 29 came to the accident and emergency department having jumped down on to a 15 cm nail. As the smallest movement of the nail was painful he was sedated with fentanyl and midazolam. The nail was then pulled out from below. When his boot was removed a miraculous cure appeared to have taken place. Despite entering proximal to the steel toecap the nail had penetrated between the toes: the foot was entirely uninjured.
As Tom mentioned “One of the things I love about it is that the builder had no incentive to ‘fake’. He knew he should have acted tough so we know that the pain he felt wasn’t over-acting. It was imaginary pain, but it was real imaginary pain!”
This isn’t really the nocebo effect, where ‘side-effects’ appear after having taken nothing but a placebo, but more similar to what doctors might describe in its persistent form as somatisation disorder where physical symptoms appear that aren’t explained by tissue damage.
However, both are similar in that real pain arises from beliefs, expectations and perceptions. We now know that all pain has a significant mental component and, consequently, psychological therapy is an effective treatment for chronic pain.
It’s no coincidence that Tom picked up this snippet in a talk by psychologist Stuart Derbyshire who has done some fantastic studies on the neural basis of psychologically controlled and induced pain by using hypnosis in fMRI scanners.
Link to brief piece in the BMJ.