The following is an article we posted on the Robbins’ Nest Blog last August. We often hear about the “placebo effect”; it seems timely to mention again the “nocebo effect.”

A placebo is typically a fake medication used as a control in a medical trial. It can have favorable effects on the individual, sometimes alleviating pain, bloating, or a depressed mood. A nocebo effect can produce the opposite result. If a patient anticipates negative side effects to a pill, he or she may actually suffer the effects even if the pill is fake. This negative effect has been largely overlooked by researchers, clinicians, and patients. In an article recently published in the journal Deutsche Arzteblatt International, researchers reviewed 31 studies demonstrating the nocebo effect. The research found that 11% of people in fibromyalgia drug trials who were taking fake medication dropped out because of side effects including nausea or dizziness. Another study reported that discontinuation rates in migraine or tension drug trials were as high as 5% due to side effects. The rates of discontinuation in statin trials ranged from 4% to 26%.

Interestingly, an Italian study asked participants with and without diagnosed lactose intolerance to take lactose for an experiment on bowel symptoms. Actually, the participants all took glucose, which does not harm the gut. A total of 44% of people with lactose intolerance and 26% of participants without lactose intolerance complained of gastrointestinal symptoms! People can also be impacted by the nocebo effect when they take real, non-placebo drugs. When patients are informed of possible side effects, the risk of feeling those side effects can increase. In one study, a group of German psychologists divided patients with chronic lower back pain into two groups for a leg flexion test. The first group was told the test would not change their pain level, while the second group was told the test could slightly increase their pain. The second group was unable to do as many flexions, and reported intensified pain.

Researchers believe that a doctor’s choice of words matter. A group of American anesthesiologists studied women about to give birth, who were all given an epidural. Some women were told, “We are going to give you a local anesthetic that will numb the area so that you will be comfortable during the procedure.” Another group was told “You are going to feel a bee sting; this is the worst part of the procedure.” Because the second statement highlighted the downside of the injection, the perceived pain was greater in that group.

So how can health care providers be honest with their patients about potential complications, yet also minimize the chances of side effects? The researchers believe better communication is the answer. While a doctor may says “it’s just going to bleed a bit” they believe more thorough communication training can help doctors be truthful yet appropriate with their patients…… nytimes.com   8/12/12

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