Movement – 149: Find out more about the nocebo effect, how it occurs, and why many patients are experiencing pain symptoms as a result of their negative expectations.
Here’s a common parenting scenario. And even if you don’t have kids, I’m sure you can relate.
You’re at the park with your little one, and they take a spill.
Nothing major or gushing blood. It roughed up the skin, but they are wailing like this might be the end.
As an A+ parent, you dig through your stash and pull out a Band-Aid. But, not just any old Band-Aid, it’s got Paw Patrol. And voila, your high-level medical care saved the limb, and they are back to playing.
I still need to research the healing effect of character bandages, but I’m pretty confident that the effect is a placebo. Meaning the bandaid had no treatment value but achieved a positive outcome through the mental suggestion that the problem was resolved.
Placebo and Nocebo
Now, let’s say you’re the extra cautious type, and instead of a Band-Aid, you pull out the whole first aid kit. You throw on the surgical gloves as you explain the risks of gangrene and flesh-eating bacteria, oh, “and, let’s hope this doesn’t need stitches!”
Finally, you get down on their eye level before applying the anti-bacterial spray, where you say in a flat voice as if their pet died…
“This is going to hurt really really bad.”
Again, you’ve provided a mental suggestion, but this goes the opposite of a placebo, called a nocebo.
Rather than a positive effect of a treatment, a nocebo provides the mental suggestion that something is bad, which increases pain and anxiety around a problem.
For the scraped knee scenario, our poor patient is now likely to be in much more pain, and ice cream is about the only thing that will save them now.
Kids stuff, right? Not even close.
People of all ages are just as prone to the power of suggestion.
Malcolm Gladwell wrote on this in his book Blink, which explained how our brains can be primed for certain actions based on our subconscious. For example, he reported on a study where students walked slower after completing puzzles with words associated with older people.
It’s a fascinating science with conflicting findings, but I believe we can all admit that we are prone to placebos. However, we are less likely to appreciate the harm caused by nocebos.
I introduce this today because it’s a major movement in treating physical pain. Many doctors and clinicians are now pointing out the harm caused by naming or how we explain common pain issues.
For example, the implication that shoulder impingement is caused by a nasty hooked acromion that is slowly grinding your tendon away is poorly supported and may worsen the issue by suggesting that your rotator cuff is screwed.
Nocebo will be an ongoing topic on our blog and in upcoming newsletters on common pain issues that Crossover Symmetry will help treat.
For now, appreciate that your brain is part of the treatment plan, and no matter if you’re a clinician, patient, or athlete, words might be causing further problems.