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Nocebo phenomena in medicine: their relevance in everyday clinical practice.
Dtsch Arztebl Int 2012; 109(26):459-65DA

Abstract

BACKGROUND

Nocebo phenomena are common in clinical practice and have recently become a popular topic of research and discussion among basic scientists, clinicians, and ethicists.

METHODS

We selectively searched the PubMed database for articles published up to December 2011 that contained the key words "nocebo" or "nocebo effect."

RESULTS

By definition, a nocebo effect is the induction of a symptom perceived as negative by sham treatment and/or by the suggestion of negative expectations. A nocebo response is a negative symptom induced by the patient's own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment. The underlying mechanisms include learning by Pavlovian conditioning and reaction to expectations induced by verbal information or suggestion. Nocebo responses may come about through unintentional negative suggestion on the part of physicians and nurses. Information about possible complications and negative expectations on the patient's part increases the likelihood of adverse effects. Adverse events under treatment with medications sometimes come about by a nocebo effect.

CONCLUSION

Physicians face an ethical dilemma, as they are required not just to inform patients of the potential complications of treatment, but also to minimize the likelihood of these complications, i.e., to avoid inducing them through the potential nocebo effect of thorough patient information. Possible ways out of the dilemma include emphasizing the fact that the proposed treatment is usually well tolerated, or else getting the patient's permission to inform less than fully about its possible side effects. Communication training in medical school, residency training, and continuing medical education would be desirable so that physicians can better exploit the power of words to patients' benefit, rather than their detriment.

Authors+Show Affiliations

Department of Internal Medicine I, Klinikum Saarbrücken, Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.deNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22833756

Citation

Häuser, Winfried, et al. "Nocebo Phenomena in Medicine: Their Relevance in Everyday Clinical Practice." Deutsches Arzteblatt International, vol. 109, no. 26, 2012, pp. 459-65.
Häuser W, Hansen E, Enck P. Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int. 2012;109(26):459-65.
Häuser, W., Hansen, E., & Enck, P. (2012). Nocebo phenomena in medicine: their relevance in everyday clinical practice. Deutsches Arzteblatt International, 109(26), pp. 459-65. doi:10.3238/arztebl.2012.0459.
Häuser W, Hansen E, Enck P. Nocebo Phenomena in Medicine: Their Relevance in Everyday Clinical Practice. Dtsch Arztebl Int. 2012;109(26):459-65. PubMed PMID: 22833756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nocebo phenomena in medicine: their relevance in everyday clinical practice. AU - Häuser,Winfried, AU - Hansen,Ernil, AU - Enck,Paul, Y1 - 2012/06/29/ PY - 2012/01/28/received PY - 2012/03/28/accepted PY - 2012/7/27/entrez PY - 2012/7/27/pubmed PY - 2013/1/11/medline SP - 459 EP - 65 JF - Deutsches Arzteblatt international JO - Dtsch Arztebl Int VL - 109 IS - 26 N2 - BACKGROUND: Nocebo phenomena are common in clinical practice and have recently become a popular topic of research and discussion among basic scientists, clinicians, and ethicists. METHODS: We selectively searched the PubMed database for articles published up to December 2011 that contained the key words "nocebo" or "nocebo effect." RESULTS: By definition, a nocebo effect is the induction of a symptom perceived as negative by sham treatment and/or by the suggestion of negative expectations. A nocebo response is a negative symptom induced by the patient's own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment. The underlying mechanisms include learning by Pavlovian conditioning and reaction to expectations induced by verbal information or suggestion. Nocebo responses may come about through unintentional negative suggestion on the part of physicians and nurses. Information about possible complications and negative expectations on the patient's part increases the likelihood of adverse effects. Adverse events under treatment with medications sometimes come about by a nocebo effect. CONCLUSION: Physicians face an ethical dilemma, as they are required not just to inform patients of the potential complications of treatment, but also to minimize the likelihood of these complications, i.e., to avoid inducing them through the potential nocebo effect of thorough patient information. Possible ways out of the dilemma include emphasizing the fact that the proposed treatment is usually well tolerated, or else getting the patient's permission to inform less than fully about its possible side effects. Communication training in medical school, residency training, and continuing medical education would be desirable so that physicians can better exploit the power of words to patients' benefit, rather than their detriment. SN - 1866-0452 UR - https://www.unboundmedicine.com/medline/citation/22833756/Nocebo_phenomena_in_medicine:_their_relevance_in_everyday_clinical_practice_ L2 - https://doi.org/10.3238/arztebl.2012.0459 DB - PRIME DP - Unbound Medicine ER -