Cutting Edge Psychology

The power of the Nocebo Effect

Posted on May 7, 2013 at 6:25 PM

The nocebo effect is essentially the opposite of a placebo effect- in either case, substances (or other forms of stimuli) can generate very real and demonstrable changes in the body. With placebo effects, the changes are positive.There are well documented reports of even cancerous tumours "melting away" after the administration of placebo medications which have no medicinal value. The placebo effect is so widespread and such a common feature of standard medical practice that medicines and procedures have to be proven as more effective than placebos in order to be approved. This is not to say that most health practitioners are consciously using the placebo effect, and deliberately giving their patients treatments which they know have no medicinal value- it is that a substantial part of the effectiveness of many/most health practices can be explained by the placebo effect- an expectation of positive change has been created, and the mind/body is able to create or contribute to the therapeutic  changes. As a common example, antidepressant drugs have been demonstrated by research to achieve their results primarily from a placebo effect. The very small advantage which antidepressants show over placebo tablets (not enough to be clinically significant) can be explained by an 'enhanced placebo effect'. As these are not actually innert substances, they will generate noticeable changes in people's neurological and bodily functioning (often, in the same way that antihystamines can make people feel a bit 'weird'). In controlled studies of antidepressants, where they have half the sample on the real thing and the other half on a fake tablet, those on the real thing are easily able to recognise this fact as they start to experience physiological changes which clue them into the fact that they are not on a placebo. As a result, they start to expect antidepressant effects, and the enhanced placebo effect kicks in. Whereas those on an obvious placebo tablet (obvious, because they have no physiological changes occuring) recognise this pretty easily, and therefore dont expect the tablet to help them overcome their depression- no placebo effect occurs.

The nocebo effect is also a very interesting phenomenon. It was first demonstrated with people who were put on 'sham' cancer drugs and who were told that there could be a range of adverse side effects, such as headaches, nausea, shakiness, fatigue, etc. A certain proportion of subjects in this type of study will actually come down with their side effects, even though they have been given an innert sugar tablet (which they were told was the anti-cancer drug). It has become apparent that all sorts of stimuli can act as nocebos, even information. A distressed and anxious person is vulnerable to alarm messages provided by credible health authorities. As an example, several years ago i heard a chiropractor warning listeners on the radio that many people were developing chronic back pain as a result of sitting with their wallets in their back pockets. He stated that this could create an imbalance in the spine, which would then result in chronic lower back pain. The only pain i have ever derived from my wallet is that it has never been qute fat enough to cause me physical pain! But this warning was an excellent example of a nocebo effect in the making. Stressed and anxious people could take his statement seriously, and end up experiencing lower back pain- not because there is anything damaging about sitting with your wallet in your back pocket, but because a supposed authority said that it was a problem. Many of the warnings from the 'pain industry' are nocebo messages. You must sit in a certain way, stand in a certain way, bend, twist and lift in a certain way- and if you dont, you will be causing damage to your spine which will result in long term chronic pain (which can, presumably, only be remedied by months or years of physical therapy- if at all. And when this ultimately fails, which physical therapies do, then the sufferer is taught how to get used to being in chronic pain). Information if accurate and helpful, can be like a hit of penicillan for the chronic pain sufferer; or if factually wrong and alarmist,  can be like a toxic sunstance which causes untold suffering. Be very careful of what information you avail yourself to.

The following article is an excellent example of research conducted on the nocebo effect, this time regarding electro-magnetic fields. Substitute the miss-information regarding the damaging effects of such fields for miss-information from the pain industry, and it is informative about a widespread social cause of chronic pain.

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Reply Back2-It
9:48 AM on May 15, 2013 
I know very well the nocebo effect. I was told by a chiropractor that I would never be 100% again, based on his reading of an MRI, which were not even consistent with the pathology of the symptoms. I lived this trauma for 1.5 years, where doctors of all stripe consistently misread my MRI transcript and automatically assigned me to a lifetime of pain. Some doctors did not even want to see me for fear of paralyzing me. So, I had the initial stiffness and heaviness that I woke up with one day, after a moth of real stress over a relationship, compounded by constant caregiving and my own emergency surgery, that went from a stiffness and tightness of what were probably my trap muscles to a pain and physical changes that "torqued" my rib cage to the extent that my ribs were becoming disjointed. This was a case of doctors doing all the harm first. My PCP even missed my bulging, infected gallbladder and called it "weak stomach muscles" ten days before it nearly burst and my emergency surgery. I am scared to death of doctors now as a rule. Most mean well, but are too rushed or harried to really examine you, and will jump on the first thing that seems logical to them, like a herniated disc causing pain. You really need to be careful. A nocebo can kill you just as a placebo can cure you.
Reply James
7:22 PM on May 15, 2013 
Yep- and excellent example of a terrible phenomenon. No wonder you are scared of doctors. I think you are right though- most mean well, but the health systems we have managed to create work against all their best intentions. I remember years ago seeing research which suggested health stats actually looked a lot better when physicians went on strike. But the nocebo messages are out there in society, and it isnt just physicians. I think the whole 'pain industry' is responsible for creating a climate of fear of activity and a lack of trust in our bodies. All nonsense, and it just adds to the creation of more and more chronic pain.
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