Our beliefs and expectations can effect our healthcare treatment positively (placebo effect) or negatively (nocebo effect).
A placebo response to a fake medication benefits our health. If we believe a sugar pill is actually an antidepressant, our expectation can trigger a reduction of depressive symptoms after taking the sugar pill.
A nocebo response to an actual medication may cause us harm. If we believe unfounded reports about specific side effects of an antidepressant, our expectation can trigger uncomfortable side effects that the antidepressant was never associated with.
An increasing number of researchers and physicians are concerned about the prevalence of nocebo effects. In one study, lactose intolerant individuals were asked to ingest lactose, but what they actually consumed was glucose. Still, 44 percent of them reported getting the stomach pain associated with drinking lactose.
Another study involved Parkinson’s patients receiving deep brain stimulation treatment. They were told that the pacemaker in their brain would be turned off although it was left on. Many patients reported increased symptoms, believing that their pacemaker was off.
Nocebo and the Brain
Researchers are finding that the placebo and nocebo effects are governed by separate brain processes. “Even if placebo and nocebo are on a continuum of expectation, different mechanisms kick-in at different points along that continuum,” said researcher Tor Wagner, University of Colorado.
The placebo experience is governed at least partly by the release of opioids. The nocebo response seems to involve the hypothalamic, pituitary, and adrenal glands, all part of the body’s stress response system.
Researchers have also discovered that anticipating pain or discomfort triggers the release of a hormone called cholecystokinin. In certain parts of the brain, cholecystokinin facilitates pain transmission through neural pathways.
Belief and Mind-Body Health
Nocebo is at least as important as the placebo effect and may be more widespresd. ~ Ted Katchuk, Harvard Placeo Studies, Beth Israel Deaconess Medical Center, Boston
It is difficult to do research on the nocebo effect since there are ethical issues involved with causing actual or anticipatory pain to study participants. However, scientists and medical professionals want to understand this phenomenon because of its effect on treatment outcomes and research results. For instance:
- A significant number of drug research volunteers receiving placebos drop out of studies after experiencing side effects from a drug they are not taking.
- Other research has shown that the information given to patients on hospital consent forms influences their treatment tolerance and recovery. Those given details of possible side effects or complications are more likely to experience them.
- There is concern that what people believe about vaccines affects vaccine efficacy, and the incidence of side effects.
Because our expectations can influence health treatment outcomes it serves us to be aware of what our expectations are, not to assume that what we hear about a medication or therapy is correct, and to ask our health care providers the questions on our mind.
Source: The Scientist
