Nocebo Effect
Original Editor - Melissa Coetsee
Top Contributors - Melissa Coetsee, Kim Jackson and Vidya Acharya
Introduction[edit | edit source]
The nocebo effect, the mirror-phenomenon to the placebo effect, is when the expectation of a negative outcome precipitates the corresponding symptom or leads to its exacerbation[1]
In contrast to the placebo effect of positive expectation which results in health benefits, the nocebo effect worsens the health status due to negative beliefs and expectations. Originally these terms were used for 'inactive' treatments (eg. sugar pill), but the words we use are an integral part of these effects.[2]
Language Matters[edit | edit source]
Research has shown that effective communication skills are paramount for delivering efficient and quality health care. More recently, research has started to show that in addition to how the medical information is delivered, the words used by health care providers are important factors in how patients cope with illness and their reports of pain intensity and disability. [3]
Impact of Language[4]
Communication[edit | edit source]
Patient-clinician communication[5]
Words[edit | edit source]
Emotive power of words[3]
Ethics[edit | edit source]
Informed Consent[edit | edit source]
One of the basic ethical duties in health care is to obtain informed consent from patients before treatment; however, the disclosure of information regarding potential complications or side effects that this involves may precipitate a nocebo effect.[1]
Evidence of Nocebo Effects[edit | edit source]
- ICU[6]
- Postural Stability[7]
- Low back pan: Routine imaging leads to worse outcomes compared to a clinical report (reassurance of incidental findings). Early MRI's for LBP results in longer length of disability, higher medical cost and worse outcomes regardless of radiculopathy (after controlling for severity and demographics)[2]
- Hyperalgesia: Higher levels of fear of pain significantly increases stress levels and is associated with increased nocebo hyperalgesia[2]
Reframing Words[edit | edit source]
In rehabilitation[8]
In Orthopaedics [2]
| Harmful Words | Reframed Wording |
|---|---|
You have to do X before "..."
|
If you do X, you can "..."
|
| You have the joint of an 80-year old | |
| Your joint is bone on bone | A lot of people without pain also have this |
| That is the worst joint I have ever seen | |
| No wonder you are in pain | This doesn't have to be a life sentence to pain |
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 Cohen S. The nocebo effect of informed consent. Bioethics. 2014 Mar;28(3):147-54.
- ↑ 2.0 2.1 2.2 2.3 Dorow B. Words that Hurt, Words that Heal. [PowerPoint presentation]. Kaiser Permanente Persistent Pain Fellowship.
- ↑ 3.0 3.1 Vranceanu AM, Elbon M, Ring D. The emotive impact of orthopedic words. Journal of Hand Therapy. 2011 Apr 1;24(2):112-7.
- ↑ Stewart M, Loftus S. Sticks and stones: the impact of language in musculoskeletal rehabilitation. journal of orthopaedic & sports physical therapy. 2018 Jul;48(7):519-22.
- ↑ Colloca L, Finniss D. Nocebo effects, patient-clinician communication, and therapeutic outcomes. Jama. 2012 Feb 8;307(6):567-8.
- ↑ Huynh KN, Rouse-Watson S, Chu J, Lane AS, Cyna AM. Unheard and unseen: The hidden impact of nocebo communication in the Intensive Care Unit. Journal of the Intensive Care Society. 2023 Nov 29:17511437231214148.
- ↑ Russell K, Duncan M, Price M, Mosewich A, Ellmers T, Hill M. A comparison of placebo and nocebo effects on objective and subjective postural stability: a double-edged sword?. Frontiers in Human Neuroscience. 2022 Aug 18;16:967722.
- ↑ Hohenschurz-Schmidt D, Thomson OP, Rossettini G, Miciak M, Newell D, Roberts L, Vase L, Draper-Rodi J. Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect. Musculoskeletal Science and Practice. 2022 Oct 21:102677.
