Q. Easing pain, then, may improve both your emotional state and your ability to cope and plan. What holistic treatments are most effective in easing pain?
A. Hypnotic suggestions have been studied primarily in laboratory settings using healthy persons but they do temporarily change individuals' ratings of pain intensity and unpleasantness, and actually produce changes in the activity of brain structures involved in processing these aspects of pain. In contrast, acupuncture, acupressure and massage have been studied using patients and they often are effective in reducing pain, although the relief is generally short-lived.

Q. Do some treatments produce long-lasting benefits?
A. Relaxation training, biofeedback and cognitive-behavioral therapy (CBT) have been associated with longer-lasting improvements. CBT refers to a package of interventions, usually involving 10-12 treatment sessions, that provide education, training and practice in effectively using pain coping strategies (e.g., relaxation skills), and skills for maintaining one's improvements. This treatment, in particular, has been shown effective in reducing pain and negative emotional states (e.g., depressive symptoms) among patients with rheumatoid arthritis and knee osteoarthritis. It also has been shown to improve ability to perform activities of daily living among patients with fibromyalgia.

Q. Several recent studies have found placebos (inactive pills) to be about as effective as some drugs and popular supplements for most patients. How does the placebo effect work?
A. Placebo effects generally produce improvements in pain or emotional states that range from 20 percent to 40 percent of those produced by active treatments. Placebo effects on pain are associated with increases in endogenous opioids or dopamine, the body's natural chemicals that normally inhibit pain in the brain. However, placebo effects usually last for shorter periods of time than those produced by active treatments such as medication.