Nocebo effects in the treatment of endometriosis

Abstract

The current approach to treating endometriosis is often inadequate or intolerable for many patients. Until more effective therapies are available, we should aim to maximize the effectiveness of our current options. Optimization may be possible by reducing nocebo effects, which are the negative therapeutic effects not directly caused by a treatment. Awareness of these effects, how they arise, and the factors influencing them, is invaluable if we aim to limit their magnitude. The unique nature of endometriosis diagnosis and management is especially prone to nocebo effects due to multiple factors, including diagnostic delays, feelings of invalidation, social transmission of expectations, and persistent symptoms despite numerous treatments. This commentary discusses the origins of these effects in people with endometriosis, methods of limiting nocebo effects, and future research directions.

Endometriosis on TikTok: Evaluating social media misinformation and the role of healthcare professionals

“…Working in tandem with chronic health influencers would allow physicians to improve their content, learn from the community, broaden their audience reach, and establish a mutually beneficial relationship between healthcare workers and health influencers. 25,26…”

“…Working in tandem with chronic health influencers would allow physicians to improve their content, learn from the community, broaden their audience reach, and establish a mutually beneficial relationship between healthcare workers and health influencers. 25,26 Limitations There were several limitations to our study. While we used a new account with a VPN in the United States to make an experimental "neutral" profile, this was limited by the TikTok application's ability to use device settings and other demographic indicators to tailor recommendations to the account holder's predicted preferences.…”

Do expectations determine postoperative disability in women with endometriosis? Study protocol for a clinical mixed-methods observational cohort study

“…The primary aim of this study is to investigate the impact of psychological factors, especially expectations for treatment course and outcomes in women with endometriosis. Given the evidence for the impact of expectations on treatment outcomes 11 19 and recommendations for being mindful of placebo and nocebo effects, 36 this is the first study considering expectations for treatment outcomes in women with endometriosis. In this way, the study contributes to close large gaps in research and treatment for a highly prevalent and burdensome group of patients.…”

“…Evidence may be given to deduce complementary psychological interventions to the current treatment process to enhance the effectiveness of the same. 36 Psychological interventions addressing expectations have been already proven efficacious in optimising (treatment) expectations and subsequently improving treatment outcomes in patients with breast cancer 3 and hot flushes 38 or reducing postoperative days spent of patients undergoing elective cardiac surgery. 39 Women with persistent endometriosis-related complaints may especially benefit from psychological interventions such as expectations management training (EXPECT) by reducing potential nocebo effects and enhancing placebo effects to obtain better treatment outcomes.…”

“SO FAR AWAY” * How Doctors Can Contribute to Making Endometriosis Hell on Earth. A Call for Humanistic Medicine and Empathetic Practice for Genuine Person-Centered Care. A Narrative Review

“…Giving patients time to tell their story and express their feelings, emphasizing that they are being listened to, makes them feel validated, supported and respected, 81 as well as reducing the entity of symptoms and down-regulating nociceptive processing, as reported in neuroimaging studies. 82 , 83 …”