The nocebo effect Cost-intensive sham drugs have stronger side effects

Expensive sham medication causes stronger side effects than cheap
If patients know when taking a medicine that it may have side effects, the symptoms often set in too. As German researchers now report, this so-called nocebo effect is exacerbated when the dummy drug is an expensive drug.

Placebos work on various ailments
It has long been known that spot drugs, so-called placebos, can help with various ailments such as chronic back pain. In addition to the "placebo effect", which is a term for most people, there is also the little-known "evil twin of the placebo", the so-called "nocebo effect". In this case, dummy medications can also have adverse effects. According to a new study, this effect is exacerbated when the putative drug is an expensive drug.

Sham medicines without active ingredients can cause side effects in patients. Researchers now report that this effect is even more pronounced if the putative drug is an expensive drug. (Image: Photographee.eu/fotolia.com)

Expensive sham medication causes stronger side effects than a cheap one
When patients are told that a particular drug can cause side effects, they often do - even if it is a drug-free sham medication.

This so-called nocebo effect is exacerbated when patients receive value information about the putative drug. An expensive sham medication causes more side effects in the test than a cheap one.

Scientists at the University Medical Center Hamburg-Eppendorf (UKE) have examined these relationships in a study; Their results have now been published in the journal "Science".

Expectations of the patients
This phenomenon can be attributed to the expectations of the patients, which can even be illustrated with imaging techniques.

"In the case of anticipatory effects, the modulating pain system is of great importance," says Alexandra Tinnermann, a scientist at the Institute for Systemic Neurosciences of the UKE in a statement.

"Expectations arising in the frontal brain can influence the processing of painful stimuli in deeper regions of the nervous system, such as the brainstem or spinal cord, through the modulating pain system," explains the expert.

In order to examine the modulating pain system under negative expectations, they have used a new method of functional magnetic resonance imaging (fMRI).

"We have shown in our study that negative expectations affect three important areas of the modulating pain system - frontal brain, brain stem and spinal cord."

Placebo and nocebo effect
In clinical studies, patients who are in the placebo group and who have received a drug without an active ingredient often report side effects. These often fit exactly to the possible side effects of the actual drug.

A dummy drug can not only help to improve the symptoms (placebo effect), but also cause the side effects of the actual drug (nocebo effect).

"In our study, we examined how value information about a drug affects the nocebo effect," says scientist Tinnermann.

In addition, the subjects received a dummy treatment without any medical active substance. To arouse a negative expectation, the subjects were told that the drug can cause side effects that lead to increased pain sensation.

In addition to this negative expectation, half of the subjects were informed that the drug is cheap and the other half that it is expensive.

The group that received the expensive dummy medicine showed a greater nocebo effect - a higher level of pain - than the group that received the cheap drug.

"The results show that the value of a drug in addition to the negative expectations can affect pain perception; the processing of pains in the spinal cord is also altered by these factors, "says Tinnermann. (Ad)