July 27, 2012

JUST LIE TO US:

What Is the Nocebo Effect? (Joseph Stromberg, 7/23/12, Smithsonian)

Last week, researchers from the Technical University of Munich in Germany published one of the most thorough reviews to date on the nocebo effect. Breaking down 31 empirical studies that involved the phenomenon, they examined the underlying biological mechanisms and the problems it causes for doctors and researchers in clinical practice. Their conclusion: although perplexing, the nocebo effect is surprisingly common and ought to be taken into consideration by medical professionals on an everyday basis.

In many of the experiments they analyzed, the suggestion or expectation of pain brought about significant increases in the amount of negative side effects experienced by participants. For example, in one study, 50 people who suffered from chronic back pain were given a flexibility test. Half were told beforehand that the test might cause some pain, while the others were not. Afterward, the first group reported a significantly higher amount of pain, despite enduring the exact same procedure.

In another experiment, the drug finasteride was administered to help relieve symptoms of prostate disease, and half the participants were told that it could cause erectile dysfunction, while the other half was kept in the dark. Forty-four percent of the first group reported that they'd experienced ED, compared with just 15 percent of the uninformed group.

The nocebo effect might even be powerful enough to kill. In one case study, researchers noted an individual who attempted to commit suicide by swallowing 26 pills. Although they were merely placebo tablets without a biological mechanism to harm the patient even at such a high dose, he experienced dangerously low blood pressure and required injections of fluids to be stabilized, based solely on the belief that the overdose of tablets would be deadly. After it was revealed that they were sugar pills, the symptoms went away quickly.

The researchers suggest that doctors reconsider conventional beliefs about pain management to avoid magnifying painful side effects. It's commonly thought that properly preparing a patient for pain--for example, "this might hurt quite a bit"--is the best way to minimize anxiety, so the patient knows what to expect. But one experiment analyzed showed that the very words used by a doctor before injecting radiographic substances affected the amount of pain experienced. The more frequently the words "sting," "burn," "hurt," "bad" and "pain" were said, the more discomfort felt by patients.

Posted by at July 27, 2012 5:35 AM
  

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