To what extent can the Nocebo Effect be dangerous to humans?

Introduction

Imagine a scenario where simply expecting the worst can make it a reality. Although the Nocebo effect may sound similar to the Placebo effect, these two phenomena are fundamentally opposite in nature. While the Placebo effect refers to a situation in which patients’ health improves due to their belief in the efficacy of the treatment, the Nocebo effect describes the adverse effect patients experience when they anticipate negative outcomes from the treatment. The term “Nocebo”, derived from the Latin word for ‘to harm’, signifies a scenario where a negative result occurs due to the belief that the treatment will harm one’s health. Owing to the rapid formation of negative perceptions as opposed to positive ones, certain specialists argue that the nocebo effect potentially exerts a more significant impact on the clinical results compared to the placebo effect.

While the placebo effect was first identified in 1799, the Nocebo effect, which denotes the harmful consequences resulting from the placebo effect, was not discovered until 1961 by Walter P. Kennedy.

Effects of the Nocebo effect

The Nocebo effect is known to manifest a wide variety of adverse effects of various symptoms and the most common examples are :

1. Pain : This is the most prevalent outcome associated with the nocebo effect. Many researches indicate that patients often describe this pain similar to ‘bee stings’

2. Muscle aches : Patients who took statins for cholesterol reported they had muscle aches as a side effect

3. Itching : Patients have reported to have itching as one of their symptoms when using skin medications

4. Memory loss : Studies have shown that people experience memory difficulties as a result of the nocebo effect.

So we know that the placebo effect is known to operate by enhancing activity in the brain’s RVM region, resulting in improved patient’s health, but the nocebo effect operates very differently. According to GoodRx Health, the nocebo effect is triggered when stress activates specific areas of the brain that are responsible for processing pain which subsequently increases sensitivity to the pain. This focuses the patient’s attention towards anticipating every potential negative effect. For extra information, the nocebo effect is frequently observed in individuals who :

• Are more afraid of feeling pain

• Experience anxiety or depression

• Had life-threatening experience with medicine or treatment in the past

• Are informed that the medication will cause side effects

• Have pessimistic personality

Conclusion

In essence, the nocebo effect involves the brain’s response to stress and negative expectation, which can lead to the manifestation of adverse symptoms or outcomes in patients.

Indeed, the nocebo effect can be more dangerous than initially perceived, as its symptoms can encompass both physical and psychological manifestations which includes, feelings of nausea, stomach pains, bloating, severe depression, loss of appetite and even sexual dysfunction.

Fortunately, there are methods to mitigate the risk of the nocebo effect. One very effective approach involves maintaining a balanced communication strategy when discussing the potential positive and negative outcomes of a treatment. Additionally, ensuring that the patient fully comprehends the rationale behind the treatment can contribute to reducing the likelihood of the nocebo effect taking hold.