drug with the effects of simply taking something. However, placebos have been shown to
have an effect on pain relief. Beecher (1955) suggested that 30 per cent of chronic pain
sufferers experience pain relief after taking placebos. In the 1960s Diamond et al. (1960)
carried out several sham operations to examine the effect of placebos on pain relief. A
sham heart bypass operation involved the individual believing that they were going to
have a proper operation, being prepared for surgery, being given a general anaesthetic,
cut open and then sewed up again without any actual bypass being carried out. The
individual therefore believed that they had had an operation and had the scars to prove
it. This procedure obviously has serious ethical problems. However, the results suggested
that angina pain can actually be reduced by a sham operation by comparable levels
to an actual operation for angina. This suggests that the expectations of the individual
changes their perception of pain, again providing evidence for the role of psychology in
pain perception.THE OUTCOME OF PAIN TREATMENT AND
MANAGEMENT – A ROLE FOR PAIN ACCEPTANCE?The psychological treatment of pain includes respondent, cognitive and behavioural
methods. These are mostly used in conjunction with pharmacological treatments
involving analgesics or anaesthetics. The outcome of such interventions has tradition-
ally been assessed in terms of a reduction in pain intensity and pain perception. Recently,
however, some researchers have been calling for a shift in focus towards pain acceptance.
Risdon et al. (2003) asked 30 participants to describe their pain using a Q factor analysis.
This methodology encourages the participant to describe their experiences in a way that
enables the researcher to derive a factor structure. From their analysis the authors
argued that the acceptance of pain involves eight factors. These were taking control,
living day-by-day, acknowledging limitations, empowerment, accepting loss of self, a
belief that there’s more to life than pain, a philosophy of not fighting battles that can’t be
won and spiritual strength. In addition, the authors suggest that these factors reflect
three underlying beliefs: (i) the acknowledgment that a cure for pain is unlikely; (ii) a
shift of focus away from pain to non pain aspects of life; and (iii) a resistance to any
suggestion that pain is a sign of personal weakness. In a further study McCracken and
Eccleston (2003) explored the relationship between pain acceptance, coping with pain
and a range of pain-related outcomes in 230 chronic pain patients. The results showed
that pain acceptance was a better predictor than coping with pain adjustment variables
such as pain intensity, disability, depression and anxiety and better work status. The
authors of these studies suggest that the extent of pain acceptance may relate to changes
in an individual’s sense of self and how their pain has been incorporated into their self-
identity. In addition, they argue that the concept of pain acceptance may be an import-
ant way forward for pain research, particularly, given the nature of chronic pain.302 HEALTH PSYCHOLOGY