To provide the public with a better understanding of recent groundbreaking research on the nocebo effect, Luana Colloca, MD, PhD, associate professor, University of Maryland School of Nursing, has written an article, “Nocebo Effects Can Make You Feel Pain,” published in Science magazine.
The nocebo effect occurs when a person has a negative expectation of a treatment outcome, leading to adverse effects that otherwise might not occur. Although patient response often can be influenced by expectations, Colloca and her research team discovered that negative reactions to treatments go beyond psychological responses and involve neurobiological mechanisms. Building on Colloca’s work and other lab research, a recent study by Alexandra Tinnermann and colleagues at the University Medical Center in Hamburg, Germany, showed that when a patient expects to experience more pain, there is an activation of the spinal cord leading to increased pain perception.
“If a patient believes the pain is getting worse, even while going through treatment, there may be an increase of the activation of pain facilitatory pathways involving the spinal cord. Tinnermann’s study is the first neurobiological demonstration that shows expectations can change brain nociception processing and make people feel more pain,” Colloca said. “This and other nocebo studies are important because they suggest that the nocebo phenomenon can change the patient response to pain sensations and painkillers.”
Often, successfully overcoming an ailment can depend on past experiences with treatment. Additionally, information provided during the consent process and in the context of patient-clinician communication may trigger nocebo responses. Nocebo effects can contribute to perceived adverse effects and influence clinical outcomes and whether or not a patient adheres to prescribed medication. Nocebo effects should be avoided during clinical trials and practices, according to Colloca. Instead of concealing information related to side effects, a better approach is to minimize nocebo response by tailoring patient-clinician communication to balance truthful information about adverse events with expectations of outcome improvement, exploring patient treatment beliefs and negative therapeutic history, and paying attention to treatment descriptions.
You can read Colloca’s article on the Science magazine website.