Nocebo Bad Twin of Placebo scares patients

The nocebo effect causes physical discomfort due to negative expectations
In contrast to the famous "placebo effect", the so-called "nocebo effect" is unknown to most people. This is a very interesting phenomenon, because instead of a positive reaction, this results in a seemingly negative effect of a drug. He can be triggered by reading the leaflet or the Google search for certain symptoms. Accordingly, the note "To risks and side effects read the leaflet and ask your doctor or pharmacist" a whole new character.

Placebo effect stands for positive effect by belief in the treatment
Most people are familiar with the so-called 'placebo effect', which is known as a positive therapeutic effect, based solely on the assumption that treatment may have occurred. The situation is different with the "nocebo effect", which until now is largely unknown. This is the disastrous counterpart to the placebo effect and causes physical discomfort and illnesses only due to negative expectations. For example, reading the leaflets with numerous side effects can significantly increase the likelihood of side effects through the nocebo effect.

The small but negative brother of placebo is the nocebo effect. (Image: Peter Hermes Furian / fotolia)

The nocebo effect is so strong that even superstition can lead to the onset of physical symptoms, possibly leading to puzzling mass phenomena in some regions of the world. Compared to "Focus Online", the head of the pain clinic at the University Hospital Essen, Prof. Ulrike Bingel explained that the "Nocebo-effects describe negative psychological or physical reactions" as the re-emergence of symptoms or symptom exacerbations, "which are triggered by negative expectations, negative beliefs or negative experience and fear. "

Conditioning and expectation responsible for the nocebo effect
The Nocebo effect works according to the statement of the psychologist Professor Dr. Paul Enck from the Medical Clinic, Psychosomatic Medicine and Psychotherapy at the University Hospital Tübingen using the same principle as the placebo effect, except that the expectation and thus the physical response is different. "By conditioning (learning), in which an earlier, positive and negative experience with drugs plays a role, and by current expectations that patients have and are nourished by suggestive information, such as on leaflets", the effects become according to Prof. Enck.

Massive physical discomfort due to the expectation
To the intensity of the physical discomfort that can be caused by the nocebo effect, reports a study by the US psychiatrist Roy Reeves of the University of Mississippi in Jackson, which was published in 2007 in the journal "General Hospital Psychiatry". Here, a young participant in the antidepressant study has tried to take his life with the given psychotropic drugs. With severe physical symptoms and a drastic sagging blood pressure, the subject was admitted to the emergency room. In the further course it turned out, however, that the 26-year-old belonged to the placebo group, so had not received any active ingredient. As soon as the doctors opened it to him, the symptoms immediately went down.

Read leaflets as a risk factor for side effects?
Less obvious, but still clearly recognizable, is the nocebo effect in numerous other studies, where participants complained, for example, of massive side effects, although they did not actually receive any medicine. In view of the influence that the nocebo effect can have on the treatment, the question arises to what extent the information provided by the physician and the information on the package leaflet regarding the threatening side effects may hinder or jeopardize the success of therapy.

Avoid nocebo effects as much as possible through empathy and understanding
However, the list of all possible side effects of a drug is currently required by law and is "expressly" desired by doctors, pharmacists, consumer protection and patient organizations: "The instructions are important for balancing the benefits and risks of individual therapy," explains Siegfried Throm from the Association of Research-based Pharmaceutical Companies (vfa) to the news agency "dpa".

In order to prevent nocebo effects in the best possible way, physicians should therefore talk to the individual patient individually and put themselves in their position. Above all, it is important to have a clear and comprehensible language, technical terms and "careless and negative comments should be avoided as far as possible," said Robert Jütte, board member of the Scientific Advisory Board of the German Medical Association in an interview with the news agency.

Patients should contact the doctor if uncertain
Although the negative effects could not be avoided with certainty, according to the medical doctor Christiane Roick of the AOK Federal Association, it could help if patients learn that their own expectation and attitude can influence the medical treatment. "If a patient is unsure by a possible side effect listed in the leaflet, then he can ask the doctor or pharmacist, how often the negative side effect has occurred so far," said the Mannheim-based psychologist and psychotherapist Doris Wolf. If the answer were "only once in ten cases", the patient should be aware that the likelihood that he might be affected is rather low, the expert continued. (fp, no)