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Usually, your doctor prescribes medicine because it will help you recover from an illness or pain that you are currently experiencing. But unfortunately, even though treatment has advanced through the years, there are still times when these medicines do not give the intended effects.

The placebo effect is a well-known concept where a person’s symptoms alleviate or they generally feel better despite only using an inactive substance, such as sugar pills. There is no possibility of a chemical benefit from such a placebo medicine itself, but the person’s belief enables their brain to do the healing itself. Therefore, the person might still claim to feel better, as if they are taking an actual medication.

The placebo effect has a darker counterpart – the nocebo effect. However, the nocebo effect is less well-known and an often ignored aspect of medical drugs. So let’s dig in deeper on nocebo.

The Nocebo Effect in a Nutshell

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In brief, the nocebo effect happens when a person feels an unlikely side-effect from a drug merely because someone tells them said drug might produce it – the mind can create those effects and even manifest them physically by itself. Their mind convinces them, consciously or subconsciously, that they will “get the side effects” because the doctor said such side effects “may” happen. 

The nocebo effect is so potent that even though the tablet you got is inactive, you might still experience physical side effects if you expect it.

Your doctor is responsible for telling you what happens to your body when receiving any treatment. As a patient, you need to know both the good and the bad. This is necessary to give informed consent as a patient. However, words are more powerful than you may think! The nocebo effect means that you can experience negative side effects just because someone who you value tells you that they may occur, even at a very small risk, because your mind internalizes their possibility and makes them happen. 

Walter Kennedy derived “nocebo” from the Latin phrase “to harm” to be the counterpart of “placebo”, derived from Latin for “I will please.” As noted by Kennedy in 1961, the nocebo effect is due to the body’s response, and not the treatment, which makes the nocebo effect potentially dangerous for patients, as relieving the symptoms isn’t as simple as stopping or changing the treatment. Doctors can see the symptoms caused by the nocebo effect because patients show actual signs like increased heart rate or blood pressure!

The biggest problem with the nocebo effect is that clinics or hospitals rarely discuss it. As a result, medical practitioners sometimes overlook the need to know the mechanics of this effect to prevent it from happening.

Nocebo vs. Placebo

The nocebo reaction revolves around this principle: 

If you expect to feel bad with a treatment, you are likely to feel poorly through this expectation alone. 

Such an effect wouldn’t happen if you have no particular negative expectations, – but without knowledge of all possible outcomes of a treatment, you could not give proper consent to it.

In contrast, the placebo effect is positive: 

When you expect a good outcome, like feeling better or being closer to recovery, this expectation alone might help you get better.

Essentially, nocebo and placebo are words for the mind’s influence on the body! Though they may be difficult to take seriously at first glance, rigorous research studies have documented them. 

Examples of the Nocebo Effect in Action

The nocebo effect is more common than you think. So, when does this effect happen?

Studies have found that by merely telling a patient like you that your treatment can have a side effect, a doctor might influence you to experience the nocebo effect. So, how your doctor describes the side effects affects the chances of succumbing to the nocebo effect.

The nocebo effect still holds mysteries for science to crack. One attempt to explain it is the concept of mental conditioning: your mind can be trained to react to something in a specific way. This might be why your mind can play tricks on you, including on your body.

The nocebo effect is also commonly found in clinical trials, an essential step to test new medications before market. Researchers are required to document any side effects reported by patients, so it can end up quite a challenge to tell apart effects actually produced by the drug from those produced by the nocebo effect.  Therefore, in these studies, there will always be a group that is given an inactive substance but told it is the real medication. Side effects experienced by this group are almost certainly from the nocebo and placebo effects.

Further instances of nocebo effects include patients sometimes feeling dizzy or nauseous upon entering a clinic to get chemotherapy, before receiving any treatment, and similarly, some patients experience more pain when the doctor informs them that a difficult or painful treatment will be performed.

Nocebo Effect and COVID-19 Vaccination: Are They Related?

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The COVID-19 pandemic necessitated treatment and vaccines to be developed quickly. Fortunately, effective COVID-19 vaccines were created, tested, and distributed in a short time. These vaccines have proven a perfect success, with more people being protected against the disease’s deadly variants every day. Unfortunately, some people are still hesitant to get their shots. And the nocebo effect might be to blame.

Many people are anxious about vaccine side effects, making their experience worse due to the nocebo effect. For instance, a COVID-19 vaccination study where participants received a sham vaccine experienced fewer initial side effects. However, they developed noticeable side effects after getting the second dose of the sham “vaccine.” In short, researchers found that nocebo may cause side effects almost as severe as individuals who received the actual vaccine.

The nocebo effect is all about how harmful health effects are induced due to how your doctor said it. Thus, more appropriate wording has been advised to promote COVID-19 immunization, to discourage the development of nocebo-induced side effects. Furthermore, educating the public about the potential for a nocebo could stop this effect in its tracks.

How Powerful Is The Nocebo Effect?

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If it is only about the mind and not the meds, you would think that nocebos are not life-threatening. However, this effect can be very strong – far more than you might think!

A report mentioned someone who attempted suicide after eating 29 placebo sugar tablets with no drug substance in them at all. Beyond the psychological effects, this person had severe low blood pressure and required medical assistance. The investigators found that doctors had previously told the individual that overdosing on the meds, which the patient thought he was taking, could be lethal. All symptoms eased once the individual heard, from the doctors, that he had taken sugar tablets with no drug. The degree of the nocebo effect on this person shows that it is potentially life-threatening.

Another study found that the words can impact a person’s pain reaction. For instance, when doctors use words like “hurt,” “sting,” or “terrible pain,” patients report having more pain and discomfort than when doctors don’t use these words.

When False Expectations Trigger Suffering

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What about negative expectations and suggestibility as the main drivers of the nocebo effect? As we underscored earlier, nocebo effects occur because of psychological factors’ primary role. For example, having negative expectations or fearing medical procedures can be hard to avoid when you go to the doctor. Studies have linked these negative expectations to manifestations of nocebo.

The media can occasionally exaggerate information regarding a bad reaction to drugs. These media storms result from sensationalizing adverse reactions to meds. Ultimately, people can feel unwanted effects from taking medications due to the negative expectations created by the sources of information they rely on and pay attention to, including mainstream news and social media.

One study showed how someone can be influenced to feel pain where there is no physical pain. A flexibility test was administered to 50 persons with persistent back pain as part of a research study. The patients who were warned they would feel some pain during the test generally reported feeling pain more often than patients who were not warned.

A similar nocebo response pattern was seen in subjects taking a medicine for their prostate disease. A possible adverse effect of this medicine is erectile dysfunction, which was only mentioned to half of the participants. In the end, 40% of the aware group had reported erectile dysfunction, whereas only 15% of the unaware group said they were affected.

Nocebo is not something new in medicine. It would be best for both the doctors and patients to watch for possible nocebo and placebo effects. You would not want to risk overdosing pills or taking the wrong drugs just because you associated your symptoms with the wrong thing.

How Can You Get Rid Of The Nocebo Effect?

How your mind works in general – your personality – influences the internal risk factors of manifesting nocebo. While externally, risk factors mainly include the wording spoken and non-verbal cues (e.g., tone of voice and facial expression) given off by doctors when informing you about possible undesirable treatment effects.

The vital question remains: how can you get rid of the nocebo effect? Since higher anxiety is generally linked to more nocebo, practicing one or more of the following can help reduce both:

  • Do your best to have earnest conversations with your doctor about your apprehensions.
  • Every day, think about the worst that can happen and accept that.
  • Make sure you sleep seven to eight hours daily.
  • Practice daily journaling.
  • Exercise regularly.
  • Meditate daily.

Are There Drugs To Help In Minimizing The Nocebo Effect?

Yes, some drugs are available to help manage or minimize the nocebo effect. These kinds of medicines target parts of your brain that get stressed out and cause the cascade leading to the nocebo effect. 

Currently, two options are analgesic diazepam and proglumide. It is best to seek a professional consult first! These are still real medicines that can be harmful if taken in the wrong dose and frequency.

In Conclusion

The nocebo effect has always existed in the world of medicine. As discussed in this article, the nocebo effect happens when individuals experience negative side effects from therapy only because they expect to do so, perhaps because a medical expert mentioned them as a possibility.

This may sound scary for you, but you will be alright as long as you follow your doctor’s prescription. There is a lot to learn from the nocebo effect to minimize the problems that patients encounter in the future.