Placebo & Nocebo

Placebo. We’ve all heard of it, but what is it exactly?

A placebo is a substance or treatment with no active therapeutic effect. The Placebo Effect is a phenomenon in which the recipient perceives an improvement in their condition due to personal expectations, rather than the treatment itself. So lessening pain through no intervention. Placebo effects are absolutely fascinating, with some placebos seemingly more effective than others; large pills seem to work better than small pills, colour pills work better than white pills, an injection is more powerful than a pill, and fake surgery gives a stronger placebo effect than injection (Ref 1)! Whilst fake surgery seems a crazy idea, the Finish Meniscal Legion Study Group’s trial published in The New England Journal of Medicine, found a sham meniscal (cartilage) surgery to be equally effective as the actual procedure. Think about that.

The use of placebo is also an interesting ethical topic for any therapist, which I wrote a little more about here.

And what of Placebo’s lesser know twin – Nocebo. The Nocebo Effect is when a negative expectation causes a treatment or therapeutic intervention to have a more negative effect than it otherwise would. It is the perception that will have a negative influence on the result, not the treatment itself. So creating more pain, through no intervention….The words we use can be incredibly nocebic; a simple diagnosis can sometimes have that effect if it is not communicated correctly. We all know someone that ‘cant’ do exercise because of the negative effect that it will have, having been told so by a health professional, and the healthcare profession is full of potentially nocebic words; “rupture” and “impingement” for example. Another classic example of this a therapist saying “…oooh, this is gonna take a least 10 treatments…”, reinforcing the persons perception that they are “in a bad way”.

This in turn leads to catastrophizing – we know from studies that we can “… successfully manipulate pain catastrophizing in positive and negative directions in both chronic pain patients and healthy volunteers and … show that these manipulations significantly influence pain levels”. So just by our words and body-language, we can alter other peoples pain state.

A classic case of catastrophizing that many a runner will be familiar with is ‘Maranoia’, where every sneeze or ache turns into a career-ending condition days before an event…

So be aware of the tricks our own brain can play on us – in both positive and negative directions, and don’t be afraid to question your health professional to clarify exactly what the treatment is setting out to achieve.

REFERENCES

Reference 1. https://books.google.co.uk/books?id=NfCDR_Yl7f0C&lpg=PA21&ots=K0nNndldOB&dq=large+pills+capsules+placebos&pg=PA21&redir_esc=y#v=onepage&q=large%20pills%20capsules%20placebos&f=false

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

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