{"id":10294,"date":"2020-04-13T10:00:13","date_gmt":"2020-04-13T14:00:13","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=10294"},"modified":"2020-07-08T18:52:49","modified_gmt":"2020-07-08T22:52:49","slug":"nocebo-effect","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/nocebo-effect\/","title":{"rendered":"What is the nocebo effect?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">It sounds far-fetched, but it\u2019s true. What you think about a medication affects how well it will work for you. In other words, if you believe that a prescription will ease your symptoms it will\u2014and vice versa. When you worry that a treatment plan will have bad side effects, or do nothing to ease your pain, it can become a self-fulfilling prophecy. It\u2019s called the nocebo effect.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is the nocebo effect?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Nocebo responses occur when your negative expectations about a treatment cause you to experience negative symptoms from taking medication. For example, if your health care provider mentions back pain as a potential adverse event, you may experience back pain\u2014even if you take a sugar pill. Or, if you read an article about how that prescription can trigger migraine, you might get a headache after taking it.<\/span> <span style=\"font-weight: 400;\">This reaction is known as the nocebo effect.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Placebo effect vs. nocebo effect<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Many people are familiar with the placebo effect. It occurs when you experience the benefits of a medication because you believe it will be helpful even if that medication is inert. The nocebo effect is the opposite phenomenon. Negative perceptions lead to ineffective treatment, even for powerful medications.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Placebo means, \u201cI will please,\u201d in Latin. Nocebo means, \u201cI will harm.\u201d Both thought patterns can have a meaningful impact on your health outcomes.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How the nocebo effect works<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">As we know from the more-studied placebo response, the power of verbal suggestion alone can cause the mind to believe the body is experiencing a positive (or in this case, negative) side effect of drugs. This means that simply mentioning those adverse effects can make you believe that you are physically experiencing those problems, according to <\/span><a href=\"https:\/\/www.nancemd.com\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">Erin Nance, MD<\/span><\/a><span style=\"font-weight: 400;\">, a New York City\u2013based orthopedic surgeon. However, practitioners are bound by medical consent to discuss all the possible risks involved with medical treatments, meaning patients will occasionally be told something negative that causes them to experience more pain and dysfunction\u2014creating a bit of an ethical dilemma.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cThese effects occur with inert treatment because a person\u2019s expectations and the conditions surrounding a treatment, or the \u2018ceremony\u2019 of a treatment, can have profound effects on our brains, and our brains have profound effects on our bodies,\u201d explains Harrison Weed, MD, an internal medicine physician at The Ohio State University Wexner Medical Center.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Additionally, patients who read through all the possible side effects listed for a medication are more likely to report suffering one or more of those side effects, as are patients who are anxious in general, or are afraid of a side effect in particular. Even patients who feel their provider doesn\u2019t care for them, is unconcerned, or too busy to know them, are more likely to report adverse effects of treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">From a neurobiological standpoint, what happens within the brain is similar to what happens when you imagine a visual scene or doing physical activity. Those parts of your brain light up. \u201cIn practical terms, imagining something is happening is enough to activate those portions of the brain associated with that thought, or worry, or pain, which leads to the perceived side effects becoming their reality,\u201d says general practitioner Giuseppe Aragona, MD.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Examples of the nocebo effect<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Nocebo responses can appear in clinical trials, everyday clinical practice scenarios, and even instances when no medication is actually prescribed or taken. Understanding the various ways the nocebo effect presents can help patients be prepared\u2014and even make it less likely to occur.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Perhaps the most obvious place people expect the nocebo effect is in clinical or drug trials. \u201cPeople in clinical trials who receive inert treatments often report higher rates of common symptoms, such as headache, stomach upset, dizziness, fatigue, or generalized weakness than do similar people not in clinical trials,\u201d says Dr. Weed. For example, a patient in a research trial receives the placebo for a new medication that helps to heal distal radius fractures faster, and is told one of the side effects is fatigue. If the patient starts to experience fatigue it is most likely due to the nocebo effect, adds Dr. Nance.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">People taking <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/statin-side-effects\/\"><span style=\"font-weight: 400;\">statins<\/span><\/a><span style=\"font-weight: 400;\"> often experience the nocebo effect. Perhaps partially because the side effects of this type of medication are so widely covered in the news, people may have negative expectations. The risk of muscle pain from taking statins is less than 5%. Yet,<\/span><a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/high-blood-cholesterol\/in-depth\/statin-side-effects\/art-20046013\" target=\"_blank\" rel=\"noopener noreferrer\"> <span style=\"font-weight: 400;\">recent studies indicate<\/span><\/a><span style=\"font-weight: 400;\"> that nearly 30% of patients stopped treatment due to muscle pain<\/span><span style=\"font-weight: 400;\">\u2014<\/span><span style=\"font-weight: 400;\">even if they were part of a control group and their treatment was actually a placebo.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Alex Tauberg, MD, even sees the nocebo effect in his chiropractic practice: On an X-ray, evidence of degenerative change is likely to be present in anyone above the age of 30. Because osteoarthritis is extremely common, we are unable to claim that osteoarthritis seen on X-rays is the cause of low back pain. In fact, osteoarthritis is just as common in people with no pain or dysfunction as it is in people with pain. \u201cYet, when we show these X-ray results to patients, it increases their pain and disability levels as they believe there is something structurally wrong with their body,\u201d Dr. Tauberg explains.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">5 ways to prevent the nocebo effect\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You don\u2019t have to be a victim to your negative expectations. Use these strategies to fend off the nocebo response.<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><b>Discuss the positives.<\/b><span style=\"font-weight: 400;\"> \u201cBeing informed while believing that you will experience a positive outcome is the best way to maximize the benefit from your treatment outcome,\u201d says Dr. Nance. \u201cIf a patient knows that postoperative tingling is less than 1%, then reframing the outcome as 99% of patients have normal sensation will help foster a positive outlook.\u201d Even if your provider doesn\u2019t deliver the information this way, it\u2019s possible for you to reframe the information in terms of positive expectations.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Focus on the benefits.<\/b><span style=\"font-weight: 400;\"> Redirect your focus to the benefits of the medication or treatment rather than the potential side effects. Using your energy to think about the positives of a medication can reduce the risk of a nocebo response, says Dr. Aragona.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Make a plan. \u201c<\/b><span style=\"font-weight: 400;\">Providers can educate patients about likely side effects and empower patients with a plan for addressing negative side effects and for informing the provider,\u201d explains Dr. Weed. Knowing that you have a plan in place for coping with a potential negative effect as well as an open channel of communication with your health care provider\u00a0 can lessen the anxiety that causes the nocebo phenomena.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Exhibit care. <\/b><span style=\"font-weight: 400;\">Providers can develop the processes and skills to show their care for their patients, including spending enough time with them. When possible, choose a medical professional who you feel cares about you and your well-being and who can and will listen to your concerns.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Be honest. <\/b><span style=\"font-weight: 400;\">Practitioners should exercise \u201c<\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22416745\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">contextualized informed consent<\/span><\/a><span style=\"font-weight: 400;\">,\u201d which takes into account possible side effects, the patient being treated, and the particular diagnosis involved, according to Ted J. Kaptchuk, BA, professor of medicine at Harvard<\/span> <span style=\"font-weight: 400;\">Medical School.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">If you have a specific concern or fear about a potential side effect, be honest with your health care provider\u00a0 or pharmacist. <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/explain-side-effects\/\"><span style=\"font-weight: 400;\">Healthcare professionals can explain how likely it is to occur<\/span><\/a><span style=\"font-weight: 400;\">. Knowing your risk is small, and what to do if you experience it, can help fend off the nocebo effect. When all else fails, think positive thoughts.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It sounds far-fetched, but it\u2019s true. What you think about a medication affects how well it will work for you. In other words, if you believe that a prescription will ease your symptoms it will\u2014and vice versa. When you worry that a treatment plan will have bad side effects, or do nothing to ease your [&hellip;]<\/p>\n","protected":false},"author":93,"featured_media":9206,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[788],"coauthors":[12463],"class_list":["post-10294","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","tag-drug-safety","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is the nocebo effect? Here\u2019s how it affects your Rx<\/title>\n<meta name=\"description\" content=\"Perception of a drug could lower its efficacy or make patients experience side effects. 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