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2016 ; 4
(2
): e00208
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The nocebo effect of drugs
#MMPMID27069627
Planès S
; Villier C
; Mallaret M
Pharmacol Res Perspect
2016[Apr]; 4
(2
): e00208
PMID27069627
show ga
While the placebo effect has been studied for a long time, much less is known
about its negative counterpart, named the nocebo effect. However, it may be of
particular importance because of its impact on the treatment outcomes and public
health. We conducted a review on the nocebo effect using PubMed and other
databases up to July 2014. The nocebo effect refers by definition to the
induction or the worsening of symptoms induced by sham or active therapies.
Examples are numerous and concerns both clinical trials and daily practice. The
underlying mechanisms are, on one hand, psychological (conditioning and negative
expectations) and, on the other hand, neurobiological (role of cholecystokinin,
endogenous opioids and dopamine). Nocebo effects can modulate the outcome of a
given therapy in a negative way, as do placebo effects in a positive way. The
verbal and nonverbal communications of physicians contain numerous unintentional
negative suggestions that may trigger a nocebo response. This raises the
important issue of how physicians can at the same time obtain informed consent
and minimize nocebo-related risks. Every physician has to deal with this apparent
contradiction between primum non nocere and to deliver truthful information about
risks. Meticulous identification of patients at risk, information techniques such
as positive framing, contextualized informed consent, and even noninformation, is
valuable.
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