Nocebo Effect

It is really common in the normal manner of speech to dismissively say that something is “just a placebo.”  What research has shown repeatedly though, is that the placebo effect can be very powerful, causing measurable changes in neurotransmitters, marked decreases in pain, and noteworthy changes in immune system function, to just name a few of the many effects.

What I want to talk about here is the placebo effect’s evil twin. This is called the nocebo effect.The nocebo effect could be described as anything said or done that has an outsized influence on the course of a condition or illness, in this case, for the worse. This can take the form of a doctor confidently saying that someone has six months to live, or getting a diagnosis that has a terrible reputation, or something as simple as getting an MRI and being told that you have a bulging disk. Sometimes it comes in the form I call a “medical curse”, where someone is told something harsh or negative in an overly confident manner that then leads to the recipient of this curse living that out.

It is important to be given clear information, but perhaps it is just as important to not have your hope killed. Sometimes it takes two or three office visits for someone who has had pain for a long time just to believe that a change can be made. Sometimes being shown the results of an MRI – results which look horrible to someone who doesn’t know that virtually everyone in pain or not in pain has a somewhat similar appearing MRI – can have a terrible nocebo effect. Even the common “bulging disk” MRI result can have a crippling effect, unless the nocebo effect is countered by knowledge that bulging disks come and go depending on the tension of the muscles in the area around the disk.

Listen to the language and tone you hear from clinicians, from family and friends, and even from yourself. Is it fearful, critical, harsh, or negative? If it is, you might want to realize the outsized effect that this can have. Just being mindful of the emotional effect of hearing something can be the first step in letting a nocebo effect go.