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“Somebody says to you ‘Oh my God, you look terrible, are you going to get sick?’ And then suddenly you are,” Charlotte Blige said, recalling a recent bus trip from Belfast to Dublin in Ireland. “You have this anticipation and it increases the symptoms.” (Also read | COVID-19: What is a placebo? Why is it used in vaccine trials?)
Bleese — a health researcher at Uppsala University, Sweden, and one of the authors of “The Nocebo Effect: When Words Make You Sick” — was feeling nauseous due to motion sickness.
She was trying to distract herself with some other thought, and knew that if someone interrupted her, it would trigger a nocebo effect.
“Nocebo effect [is] “Negative health consequences stem from negative expectations,” Bleese told DW. “It can increase feelings of pain, anxiety, nausea and fatigue.”
Nocebo: not placebo
The nocebo effect is the negative mirror image of the placebo effect.
Imagine a clinical trial. One group is given actual medicine to treat headaches. The other group receives sugar pills without any active ingredient.
When patients in this second group report a reduction in their headaches, doctors say the patients are experiencing a placebo effect – because they thought they were taking painkillers that, like the patients in group one, were positive. Thinking led to positive results in his treatment.
This is a medically recognized phenomenon. And the nocebo effect is slowly gaining similar recognition by health professionals, except it’s exactly the opposite: It’s when negative thinking negatively affects your results.
Nocebo effect, Covid and vaccine hesitancy
During the coronavirus pandemic, researchers found that people’s expectations before a COVID-19 vaccination may be linked to how they felt afterward.
A team of scientists from Israel and the UK looked at a group of 756 Israeli adults over the age of 60. Each had received a booster shot – the third vaccine against COVID-19.
“We looked at both vaccine hesitancy – one’s negative attitude or expectations toward the vaccine – and the number of subjectively reported side effects,” said Yaakov Hoffman, lead author of the study and professor in the Department of Social and Health Sciences at Bar-Ilan. Measured.” University, Israel.
Published in the journal Scientific Reports in December 2022, their results indicated that people who had negative expectations before their second shot were more likely to experience side effects after the third.
“More concerns about the vaccine, its safety and its side effects [one felt]”The older he gets, the more likely he will really experience side effects,” Hoffman told DW.
And when the nocebo effect and vaccine hesitancy were combined, he said, it had the potential to create a vicious cycle: A person who was hesitant to get vaccinated, perhaps because they had read about side effects online, was more likely to feel side effects. Will be more likely to experience effects. Those side effects will then be recorded and reported by their doctor. This, in turn, will contribute to more media coverage about side effects, and more people feeling hesitant about vaccines… and so on, and so on.
How do doctors deal with the nocebo effect?
Talking to patients without triggering the nocebo effect can be a challenge.
“Doctors have an obligation not to harm patients, or to minimize harm where possible, but they also have an obligation to tell the truth,” Blease said.
In the case of a vaccine with relatively minor side effects, it may make sense to directly address the nocebo effect, Hoffman said.
“Maybe it would be better to be somewhat blunt and say, ‘There’s a certain percentage of side effects that you’re experiencing that are nocebo effects.’ That means you’re actually experiencing them, but that’s not necessarily true. That should be a danger signal,” he said.
However, Hoffman stressed that this was only speculation and that further research was needed to provide solid evidence.
Importance of preparing health information
Other experts in the field agree that changing the way doctors communicate with patients can help prevent the nocebo effect.
“How doctors talk to patients can influence the outcomes of therapy,” said Professor Ulrike Bingel, head of the pain research unit at the University Hospital Essen in Germany, a clinical neurosciences professor.
“Until now, communication has mostly been seen as a feel-good issue. We need more awareness of how important it is,” Bingel said.
For example, when it comes to vaccines, doctors are required to disclose any potential side effects.
But Bingel said that instead of creating a list of side effects that scares patients, doctors should frame the side effects as a sign that the immune system is working well.
This way, the patient may have less negative expectations and experience fewer or less-obvious side effects.
Nocebo effect may be evolutionary
But how can negative thoughts in our minds affect what’s going on in our bodies?
First, it’s important to understand that the nocebo effect is real. This is not a patient’s pessimistic imagination.
“Nocebo and placebo effects involve complex neuroscientific processes,” Bingel told DW. “When you’re experiencing the nocebo effect, your body stops pumping its pain brakes. Your brain receives more brain impulses and you feel more pain.”
The problem is that researchers can’t explain why this happens. not yet. But he believes it may have something to do with our evolution.
“It was important that our ancestors learned from exposure to a wild animal or poisonous plant,” Bingel said. “Body [got] Ready for next time.”
In other words, early man’s negative expectations may have prepared him if he had to run for his life.
“The nocebo effect may be a hangover from the past,” Blease said. [but] “It is a mismatch for today’s modern medical environment.”
Edited by: Zulfikar Abbani
Source:
The Nocebo Effect: When Words Make You Sick, by Michael Bernstein, Charlotte Blies, Cosima Locher, Walter Brown. Mayo Clinic Press, March 19, 2024.
YSG Hoffman, Y. Levin, Y. Vaccine hesitancy potentially predicts nocebo side effects after COVID-19 vaccination by Palgi et al. Scientific Report, 2022:
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