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It is not just the drugs that matter: the nocebo effect.
Cancer Metastasis Rev 2019; 38(1-2):315-326CM

Abstract

The role of psychological mechanisms in the treatment process cannot be underestimated, the well-known placebo effect unquestionably being a factor in treatment. However, there is also a dark side to the impact of mental processes on health/illness as exemplified by the nocebo effect. This phenomenon includes the emergence or exacerbation of negative symptoms associated with the therapy, but arising as a result of the patient's expectations, rather than being an actual complication of treatment. The exact biological mechanisms of this process are not known, but cholecystokinergic and dopaminergic systems, changes in the HPA axis, and the endogenous secretion of opioids are thought to be involved. The nocebo effect can affect a significant proportion of people undergoing treatment, including cancer patients, leading in some cases to the cessation of potentially effective therapy, because of adverse effects that are not actually part of the biological effect of treatment. In extreme cases, as a result of suggestions and expectations, a paradoxical effect, biologically opposite to the mechanism of the action of the drug, may occur. In addition, the nocebo effect may significantly interfere with the results of clinical trials, being the cause of a significant proportion of complications reported. Knowledge of the phenomenon is thus necessary in order to facilitate its minimalization and thus improve the quality of life of patients and the effectiveness of treatment.

Authors+Show Affiliations

Department of Oncology, Medical University of Białystok, 12 Ogrodowa St., 15-027, Bialystok, Poland. Department of Clinical Oncology, Comprehensive Cancer Center, Bialystok, Poland.Department of Philosophy and Human Psychology, Medical University of Białystok, Białystok, Poland. Robinson College, Cambridge University, Cambridge, UK.Department of Oncology, Medical University of Białystok, 12 Ogrodowa St., 15-027, Bialystok, Poland. Department of Clinical Oncology, Comprehensive Cancer Center, Bialystok, Poland.Department of Oncology, Medical University of Białystok, 12 Ogrodowa St., 15-027, Bialystok, Poland. Department of Clinical Oncology, Comprehensive Cancer Center, Bialystok, Poland.Department of Philosophy and Human Psychology, Medical University of Białystok, Białystok, Poland.Bioactive Lipids Research Program, Department of Pathology-School of Medicine, Detroit, MI, USA. k.v.honn@wayne.edu. Department of Chemistry, Wayne State University, Detroit, MI, USA. k.v.honn@wayne.edu. Department of Oncology, Karmanos Cancer Institute, Detroit, MI, USA. k.v.honn@wayne.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31203560

Citation

Wojtukiewicz, Marek Z., et al. "It Is Not Just the Drugs That Matter: the Nocebo Effect." Cancer Metastasis Reviews, vol. 38, no. 1-2, 2019, pp. 315-326.
Wojtukiewicz MZ, Politynska B, Skalij P, et al. It is not just the drugs that matter: the nocebo effect. Cancer Metastasis Rev. 2019;38(1-2):315-326.
Wojtukiewicz, M. Z., Politynska, B., Skalij, P., Tokajuk, P., Wojtukiewicz, A. M., & Honn, K. V. (2019). It is not just the drugs that matter: the nocebo effect. Cancer Metastasis Reviews, 38(1-2), pp. 315-326. doi:10.1007/s10555-019-09800-w.
Wojtukiewicz MZ, et al. It Is Not Just the Drugs That Matter: the Nocebo Effect. Cancer Metastasis Rev. 2019;38(1-2):315-326. PubMed PMID: 31203560.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - It is not just the drugs that matter: the nocebo effect. AU - Wojtukiewicz,Marek Z, AU - Politynska,Barbara, AU - Skalij,Piotr, AU - Tokajuk,Piotr, AU - Wojtukiewicz,Anna M, AU - Honn,Kenneth V, PY - 2019/6/17/pubmed PY - 2019/6/17/medline PY - 2019/6/17/entrez KW - Cancer KW - Nocebo KW - Nocebo effect KW - Nocebo mechanism KW - Pharmacotherapy KW - Psychobiology SP - 315 EP - 326 JF - Cancer metastasis reviews JO - Cancer Metastasis Rev. VL - 38 IS - 1-2 N2 - The role of psychological mechanisms in the treatment process cannot be underestimated, the well-known placebo effect unquestionably being a factor in treatment. However, there is also a dark side to the impact of mental processes on health/illness as exemplified by the nocebo effect. This phenomenon includes the emergence or exacerbation of negative symptoms associated with the therapy, but arising as a result of the patient's expectations, rather than being an actual complication of treatment. The exact biological mechanisms of this process are not known, but cholecystokinergic and dopaminergic systems, changes in the HPA axis, and the endogenous secretion of opioids are thought to be involved. The nocebo effect can affect a significant proportion of people undergoing treatment, including cancer patients, leading in some cases to the cessation of potentially effective therapy, because of adverse effects that are not actually part of the biological effect of treatment. In extreme cases, as a result of suggestions and expectations, a paradoxical effect, biologically opposite to the mechanism of the action of the drug, may occur. In addition, the nocebo effect may significantly interfere with the results of clinical trials, being the cause of a significant proportion of complications reported. Knowledge of the phenomenon is thus necessary in order to facilitate its minimalization and thus improve the quality of life of patients and the effectiveness of treatment. SN - 1573-7233 UR - https://www.unboundmedicine.com/medline/citation/31203560/It_is_not_just_the_drugs_that_matter:_the_nocebo_effect L2 - https://doi.org/10.1007/s10555-019-09800-w DB - PRIME DP - Unbound Medicine ER -