Why Pain Treatments Don’t Work for Everyone

Ever walked into a clinic or started a new treatment with the quiet hope, “This one will finally fix it for me”? If so, you’re not alone. Both patients and practitioners face the recurring frustration of treatments that just don’t “click.” Let’s break down why that’s a normal part of managing chronic pain - and in fact if you do respond to treatment - you’re the outlier.

The Expectation Trap

We’ve all been there—trying medication after medication, or therapy after therapy, only to find that the improvements don’t match our hopes. That process, while agonizing, is standard in chronic pain management. Treatments aren’t “magic bullets.” If they were, we’d use them for everyone. But medicine, especially pain medicine, doesn’t deal in certainties.

Understanding Number Needed to Treat (NNT)

Let’s get technical for a second. There’s a term called the “Number Needed to Treat” (NNT). It’s a measure of how many people need a certain treatment before one of them sees benefit directly from that treatment rather than from chance or placebo. For example:

●      Amitriptyline for neuropathic pain: NNT = 4 (treat four to help one)

●      Duloxetine: NNT = 6

●      Gabapentin/Pregabalin: NNT = 8

What does that mean for you? If you don’t respond to the first, or second, or even third option, you’re actually in the majority—not the minority. And improvement is typically defined as just a 30% reduction in pain for these studies—which, let’s be real, isn’t always the dramatic outcome people want.

The Placebo Effect is Real

A good chunk of people will experience a benefit from the context, attention, and hope surrounding treatment—even if the pill is a placebo. Sometimes, your “improvement” might have more to do with your body’s natural “do-it-yourself” mode than the treatment itself. That’s normal too and doesn’t make you a faker.

Context Matters

Different pain types, different results. For back pain, NNTs for common treatments to get even 30% relief look like:

●      Exercise: NNT = 7

●      Oral anti-inflammatories: NNT = 6

●      Acupuncture: NNT = 6

●      Capsaicin cream: NNT = 6

●      Duloxetene: NNT = 10

●      Opiods: NNT = 16

Even among “proven” treatments, the probability of strong benefit varies and can be less than what popular perception suggests.

The Ecological Fallacy: Why Statistics Don't Dictate Your Outcome

Another important idea: applying group data to the individual can mislead. Think of a classroom—the average height is five foot four, but that doesn’t mean every new student shares that height. Clinical trials report averages, but individual responses swing wildly. Some people get 100% relief, others get none. The average just hides that diversity of being above or below “the norm”.

You’re Not Broken—This is Normal

Just because a treatment hasn’t worked for you doesn’t mean you’re beyond help or that medicine is failing you. This situation is standard for virtually everyone dealing with chronic pain. You’re part of the majority—and though frustrating, that can also be oddly comforting. Having expectations that match reality helps the disappointment and frustration along the journey. Continue chipping away at different treatment options, and controlling the pieces you can.

For more insight and practical advice, tune in to episode 8 of It’s Not in Your Head Podcast.