The nocebo effect: A clinicians guide

Abstract

The nocebo effect is a common, clinically significant, yet covert driver of clinical outcomes. Increased awareness of its features, as well as knowledge of strategies on how to manage it, are fundamental so that clinicians can mitigate its impact on clinical practice.

The power and value of placebo and nocebo in painful osteoarthritis

“…For example: health-care interventions can sometimes result in idiosyncratic, unexpected adverse effects in individual patients [27]; sham pills used as 'controls' in RCTs often cause adverse side-effects [28]; and population-based interventions, such as the introduction of mobile phones or wind farms, can result in widespread, unexplained illness [29,30]. These are examples of what have been called 'adverse outcomes resulting from negative expectations' [31] because most investigators have assumed that expectations are responsible for the effects observed.…”

Incidence and characteristics of the nocebo response from meta‐analyses of the placebo arms of clinical trials of olanzapine for bipolar disorder

“…Administering an essentially inert substance to a patient or a study participant can influence clinical outcomes such as symptom severity, including improvement or worsening, and may elicit treatment‐emergent adverse events(TEAEs). These phenomena, known as the placebo (improvement) or nocebo (worsening or adverse events) effects, occur commonly and are of varying intensity, are challenging to predict, and may be difficult or impossible to distinguish from the natural progression of some illnesses or naturally occurring adverse events . This concept has been extended to include not only inert substances, but also non‐inert or pharmacologically active substances that are not considered to be effective for the index symptoms being treated …”

Biological phenotypes underpin the physio‐somatic symptoms of somatization, depression, and chronic fatigue syndrome

“…v) Illness investment and abnormal illness behaviour drive somatization and mood symptoms (27,28). Somatization is often seen as an alternative mode for the expression of distress and can manifest as expectation of harm secondary to medical intervention-the nocebo effect (29).…”