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The nocebo effect of drugs.
Pharmacol Res Perspect 2016; 4(2):e00208PR

Abstract

While the placebo effect has been studied for a long time, much less is known about its negative counterpart, named the nocebo effect. However, it may be of particular importance because of its impact on the treatment outcomes and public health. We conducted a review on the nocebo effect using PubMed and other databases up to July 2014. The nocebo effect refers by definition to the induction or the worsening of symptoms induced by sham or active therapies. Examples are numerous and concerns both clinical trials and daily practice. The underlying mechanisms are, on one hand, psychological (conditioning and negative expectations) and, on the other hand, neurobiological (role of cholecystokinin, endogenous opioids and dopamine). Nocebo effects can modulate the outcome of a given therapy in a negative way, as do placebo effects in a positive way. The verbal and nonverbal communications of physicians contain numerous unintentional negative suggestions that may trigger a nocebo response. This raises the important issue of how physicians can at the same time obtain informed consent and minimize nocebo-related risks. Every physician has to deal with this apparent contradiction between primum non nocere and to deliver truthful information about risks. Meticulous identification of patients at risk, information techniques such as positive framing, contextualized informed consent, and even noninformation, is valuable.

Authors+Show Affiliations

Centre Régional de Pharmacovigilance Grenoble University Hospital Grenoble France.Centre Régional de Pharmacovigilance Grenoble University Hospital Grenoble France.Centre Régional de Pharmacovigilance Grenoble University Hospital Grenoble France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27069627

Citation

Planès, Sara, et al. "The Nocebo Effect of Drugs." Pharmacology Research & Perspectives, vol. 4, no. 2, 2016, pp. e00208.
Planès S, Villier C, Mallaret M. The nocebo effect of drugs. Pharmacol Res Perspect. 2016;4(2):e00208.
Planès, S., Villier, C., & Mallaret, M. (2016). The nocebo effect of drugs. Pharmacology Research & Perspectives, 4(2), pp. e00208. doi:10.1002/prp2.208.
Planès S, Villier C, Mallaret M. The Nocebo Effect of Drugs. Pharmacol Res Perspect. 2016;4(2):e00208. PubMed PMID: 27069627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The nocebo effect of drugs. AU - Planès,Sara, AU - Villier,Céline, AU - Mallaret,Michel, Y1 - 2016/03/17/ PY - 2015/05/06/received PY - 2015/11/09/revised PY - 2015/11/20/accepted PY - 2016/4/13/entrez PY - 2016/4/14/pubmed PY - 2016/4/14/medline KW - Anxiety KW - cholecystokinin KW - hyperalgesia KW - nocebo effect KW - placebo effect SP - e00208 EP - e00208 JF - Pharmacology research & perspectives JO - Pharmacol Res Perspect VL - 4 IS - 2 N2 - While the placebo effect has been studied for a long time, much less is known about its negative counterpart, named the nocebo effect. However, it may be of particular importance because of its impact on the treatment outcomes and public health. We conducted a review on the nocebo effect using PubMed and other databases up to July 2014. The nocebo effect refers by definition to the induction or the worsening of symptoms induced by sham or active therapies. Examples are numerous and concerns both clinical trials and daily practice. The underlying mechanisms are, on one hand, psychological (conditioning and negative expectations) and, on the other hand, neurobiological (role of cholecystokinin, endogenous opioids and dopamine). Nocebo effects can modulate the outcome of a given therapy in a negative way, as do placebo effects in a positive way. The verbal and nonverbal communications of physicians contain numerous unintentional negative suggestions that may trigger a nocebo response. This raises the important issue of how physicians can at the same time obtain informed consent and minimize nocebo-related risks. Every physician has to deal with this apparent contradiction between primum non nocere and to deliver truthful information about risks. Meticulous identification of patients at risk, information techniques such as positive framing, contextualized informed consent, and even noninformation, is valuable. SN - 2052-1707 UR - https://www.unboundmedicine.com/medline/citation/27069627/The_nocebo_effect_of_drugs_ L2 - https://doi.org/10.1002/prp2.208 DB - PRIME DP - Unbound Medicine ER -