Explaining the Mechanisms of Nocebo Effects

The descending modulatory system orchestrates the effects of pricing on nocebo hyperalgesia. Anticipation of upcoming high painful stimulation makes healthy study participants perceive non-painful and low-painful stimulations as painful and high-painful stimulations, respectively. Verbally-induced nocebo effects are as strong as those induced through actual exposure to high pain.2 Moreover, receiving a placebo after a simulation of an effective analgesic treatment as compared to receiving the same placebo intervention after a treatment perceived as ineffective produce 49.3% versus 9.7% pain reductions. Anticipation of a given side effect and negative prior experience, bad interactions between clinicians and patients and the general psychosocial context surrounding the patient, can create clinically relevant nocebo effects. This talk will illustrate how verbal communication and contextual cues associated with any treatment, and other aspects of the physician-patient interactions, are important elements to prevent unwanted nocebo effects. Strategies of framing information, optimal doctor-patient interactions, and effective managing of symptoms represent promising ways for lessening clinical nocebo effects.