What Is The Nocebo Effect?

We have all heard of the famous “placebo effect.” It is even possible that we have experienced it many times in our life. There are countless studies that support it, something that does not happen with its opposite, the unknown “nocebo effect”. This occurs in similar circumstances, but published research is scarce, which gives the term a certain mysticism.

The “placebo effect” has been one of the allies of doctors and researchers for years. On the one hand, it is very effective in conducting experiments without harming the subjects; on the other, it allows the specialist to rule out serious ailments, some of a much milder nature.

It is not strange to find situations in which the parents themselves, faced with an exaggerated pain expressed by their children, give them a candy telling them that it is a painkiller. Most of the time it usually works (as long as it is not a case of force majeure), showing us that the suggestion is more powerful than we think.

What is the nocebo effect?

Like its antagonist, the nocebo effect works because of false expectations. The difference is that in the latter they are quite negative. The patient believes that the drug may cause adverse effects, which most of the time end up manifesting.

These effects disappear the moment the subject discovers that he is being falsely informed. The incredible neurological process that produces these alterations is due to the stimulation of the prefrontal, orbifrontal and anterior cingulate cortex. The same occurs with the amygdala, the spinal cord, the periaqueductal gray matter and the nucleus accumbens, which according to magnetic resonance studies affect the perception of health.

We must also take into account the importance of the environment, the attitude of the person himself and the way of administration of the nocebo. In general, studies on this effect are not without controversy due to their ethical confrontation.

Prescribing an inert treatment to a patient without telling the truth can lead to many problems. The controversy centers on the figure of the doctor, whose task is to try to minimize the symptoms, not worsen them and much less provoke them.

The price of the drug, a determining factor in the nocebo effect

According to a study recently published in the journal Science, the price of the drug has a great influence on this unconscious reaction. A group of researchers distributed jars filled with cream to a sample of 49 subjects. Participants were told that this was a trial to treat atopic dermatitis using two substances that were actually one.

The blue bottles (associated with a high price and quality) contained the same cream as the red bottles (associated with more affordable medicines). The volunteers were told that they were likely to experience a burning sensation, due to the hypersensitivity of the skin. They had to put it on for half an hour, and then undergo a device that would generate heat.

Despite what it might seem, the results were truly illuminating. People who had received the cream from the blue bottle reported feeling more pain than those in the other group. This is because the participants associated the more expensive cream with stronger effects. A psychological deception that kept repeating itself over and over again, with greater intensity.

On the other hand, the researchers found that the areas of the brain that were activated during the study were the same as those of the “placebo effect.” The main distinction lay in the gray matter, which made it through different populations of neurons.  In this way, it was found that although the same areas were involved, the activation patterns were very different.

The nocebo and fibromyalgia

Similar experiments have been carried out with fibromyalgia patients. After discovering that those who suffer from this pathology are the most likely to experience the negative effects of a drug, it was decided to treat a group with nocebos. These, completely innocuous, caused such discomfort to the patients that many of them even had to abandon the treatment.  

The “nocebo effect” makes us rethink many doubts. To begin with, why isn’t there more research on this? then, if really its effects are so spectacular in all people. Although there are no studies on personality that reinforce this, it is true that the motivation of an individual can infer the results. 

People who are obsessed with the supposed changes produced by the drug are more likely to feel pain. The brain, once again, is a powerful weapon that you have to know how to handle. The hypochondria that arises in some cases can negatively influence the symptoms of a patient.

If we can control how we deal with what we fear, it will be more difficult to experience the “nocebo effect”, also known as the evil brother of the placebo effect.