self selected population, taking the pills on schedule.
This is important for chronic pain: if you only take the medicine "as needed" sometimes it won't work, and you do need a narcotic to treat that level of pain... the dirty little secret is people tend to "bear it" with pain, until they can't stand it, meaning the problem is not just pain but anxiety that the pain won't go away: and the pill won't work fast enough or be strong enough to eliminate the severe pain complex, so you think it doesn't work. But opioids not only relieve the pain but they relieve the anxiety of hurting.
and a lot of people only want a few percocet to keep in their medicine cabinet "just in case" (e.g. when you wake up at 3 am hurting) and don't take them anyway.
taking medicine as ordered is important for those with chronic pain so you get a steady decrease in the level of pain: often to a low level that folks can tolerate.
the non fancy part, talking and comforting, is important, as is reawssuring the patient: But low tech medicine often cures but rarely gets into the headlines.
for example when we had a diabetes ulcer program at our hospital, the doctor in charge told us that there were many "double blind" studies on what salve etc is best to help these wounds to heal: and they all worked. Why? Because the important part wasn't the salve etc you used, but the fact that you were cleaning and dressing the wound properly and meticulously.
of course, the placebo effect doesn't work in everyone: I suspect like hynosis it is a neurophysiological ablity that people have in varying degrees.
See also this 2011 article in the NewYorker about the ritual of medicine and Placebo effect.
the bad news: The economic takeover of medicine by big business and government mean you don't have time to talk to the patient and evalute him or her, comfort him or her, or make sure they know how to take their medicines.
The dirty little secret is that a huge percentage of patients don't fill their prescriptions or take them properly, (Stanford report says 60 percent don't) which is why all those scientific clinical studies don't always work in real life.
Also, despite the emphasis on filling out paper work and doing testss and being efficient, the simple comfort of the art of medicine, taking time to see and talk to and examine the patient, is what helps.
From the Newyorker article:
He conducted a thorough examination, and then we talked. He told me I was fine, that Thanksgiving is often a tense time, and that I should relax. My pain suddenly disappeared. I have written frequently of my belief that magic is for fairy tales and science is for humans. But something about that process soothed me. Of course, it was a relief to know that I wasn’t sick. But could words really banish a pain I had struggled with for hours?
After I got home, I realized that I had been given a placebo. Not purposefully, perhaps, but it had the same effect. My doctor told me that I was fine, and that made my pain go away. It also eased my anxiety at least as effectively as if I had swallowed a pill. My doctor takes an extremely science-based approach to his work. That’s what makes him so good at his job.