TMJ 'dysfunction' - Health implications

The Nocebo Effect
Posted: 25 Oct 2012 05:30 PM PDT
Epub: Data-Franco & Berk. The nocebo effect: A clinicians guide. Aust N Z J Psychiatry. 2012 Oct 23.

This paper aimed to provide an overview on the nocebo effect and evidence-based strategies for management and minimisation of the nocebo effect.

The nocebo effect refers to non-pharmacodynamic, harmful or undesirable effects occurring after inactive [ineffective] treatment, a phenomenon that also occurs in the context of active therapy. Known drivers include classical conditioning and negative expectations concerning treatment. Recent meta-analyses have reported a considerable prevalence, ranging from 18% in the symptomatic treatment of migraine, to more than 74% in multiple sclerosis.

Recognition of the nocebo-driven adverse effects presents a challenge, especially because of its non-specific nature and the similarity to the active medication's expected profile. Traits such as neuroticism, pessimism and type A personalities may predispose individuals to this phenomenon.

Clinical management of the nocebo effect includes awareness and recognition, changing the manner of disclosure of potential drug-related adverse effects, shaping patients' expectations and enhancing the treatment alliance.

It is concluded that the nocebo effect is a common, clinically significant, yet covert driver of clinical outcomes. Increased awareness of its features, as well as knowledge of strategies on how to manage it, are fundamental so that clinicians can mitigate its impact on clinical practice.

"The nocebo response refers to harmful, unpleasant, or undesirable effects a person manifests after receiving a dummy drug or placebo. Nocebo responses are not chemically generated and are due only to the subject's pessimistic belief and expectation that the inert drug will produce negative consequences."

"In these cases, there is no 'real' drug involved, but the actual negative consequences of the administration of the inert drug, which may be physiological, behavioural, emotional, and/or cognitive, are nonetheless real."

Comment: This is a phenomenal finding. It introduces a chance from 18% to 74% of an effect which is unreal whether the drug is a sugar pill or a real drug. It puts into serious doubt when claims of slight positive effects of any drug therapy are made!