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To: TheBusDriver who wrote (11355)	11/8/2002 10:28:26 AM
From: axial	Respond to of 14101

"You sure they are not struggling with the delivery system and not being able to quantify pain and pain relief? They seem to accept pills better" Yes, that's it, in part. You're right. If I recall correctly, around 30% of patients experience the placebo effect - that is, they will experience some kind of relief when nothing but water (mixed with a little DMSO to fool them) is applied. Then, of course, there are the native effects of DMSO, itself, which we already know. Then, there are the effects of diclofenac. So what is the nature of the benefit? What can you say about it? As you say, they know better how to establish these things in systemically administered drugs - pills, injections. They've worked that out: at least, to the extent that hundreds of pills and injections exist, and are approved. But something like Pennsaid is new to them. We know - and you know - the stuff is great. Strange as it may seem, that obvious fact is not clear - not as clear - in the data. The WOMAC pain scores (that dry data) are nowhere near your intuitive response to the relief you got. Quantifying what's perfectly clear to us is at the heart of the matter. Jim