The Nocebo Effect and Its Relevance for Clinical Practice

  title={The Nocebo Effect and Its Relevance for Clinical Practice},
  author={Luana Colloca and Franklin G. Miller},
  journal={Psychosomatic Medicine},
Negative expectations deriving from the clinical encounter can produce negative outcomes, known as nocebo effects. Specifically, research on the nocebo effect indicates that information disclosure about potential side effects can itself contribute to producing adverse effects. Neurobiological processes play a role in the nocebo effect, and this article provides a selective review of mechanistic research on the nocebo effect. Comparatively little attention has been directed to clinical studies… 
The nocebo effect of drugs
The verbal and nonverbal communications of physicians contain numerous unintentional negative suggestions that may trigger a nocebo response, which raises the important issue of how physicians can at the same time obtain informed consent and minimizeNocebo‐related risks.
The nocebo effect: should we be worried?
Research on nocebo effects affirms the need for rethinking the ethics of patient–clinician communication, informed consent and, perhaps more importantly, the decision-making processes.
The Clinical Implications of Nocebo Effects for Biosimilar Therapy
When biosimilars are introduced to patients as possible treatment options, adoption of nocebo-reducing strategies to avoid negative expectations are recommended, including delivery of balanced information on risk–benefit profiles, framing information to focus on positive attributes, and promoting shared decision-making processes along with patient empowerment.
Nocebo Effects: The Dilemma of Disclosing Adverse Events
This work discusses state-of-the art nocebo research and associated clinical and ethical implications, and discusses the ethical conundrum as the patient has the right to be informed about potential risks and side effects of a treatment, yet a detailed disclosure may produce undesirable harm.
Nocebos in rheumatology: emerging concepts and their implications for clinical practice
The consideration of nocebos is important in rheumatology practice and clinical trial design, including when switching patients to biosimilars, andPhysicians should be aware of the risk factors for nocebo effects, which can be categorized as features relating to the patient, physician, disease, health-care setting or drug.
The influence of the nocebo effect in clinical trials
Neurobiological and clinical studies have shown that learning mechanisms and expectations of benefits powerfully affect the brain, mind, and body, with the potential of reliev - ing many symptoms
Nocebo effects in clinical studies: hints for pain therapy
To minimize nocebo effects in clinical settings, five contextual aspects relevant to the treatment of patients with chronic pain are identified and discussed, including negative patient–clinician communication and interaction during treatment and emotional burden of patients during treatment with analgesic medication.
Nocebo effects in health psychology
An overview of evidence‐based interventions to reduce nocebo effects by targeting each of the underlying mechanisms is presented, and the more overlooked mechanisms of anxiety and classical conditioning are emphasised.
The nocebo effect: patient expectations and medication side effects
This field of research has ethical and clinical implications for both medical professionals and the news media with respect to the level and type of information about treatment side effects that is provided to patients or members of the public.


Nonspecific medication side effects and the nocebo phenomenon.
A focused review of the literature identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms.
When words are painful: Unraveling the mechanisms of the nocebo effect
Getting the pain you expect: mechanisms of placebo, nocebo and reappraisal effects in humans
  • I. Tracey
  • Psychology, Medicine
    Nature Medicine
  • 2010
New research findings have directly contributed to an increased understanding of how placebo and nocebo effects are produced and what biological and psychological factors influence variances in the magnitude of the effect.
Overt versus covert treatment for pain, anxiety, and Parkinson's disease
Evaluation of the nocebo effect during oral challenge in patients with adverse drug reactions.
It is confirmed that the nocebo effect occurs frequently in clinical practice and is mandatory to recognize false positive responses in managing adverse drug reactions through oral challenge.
The nocebo effect during oral challenge in subjects with adverse drug reactions.
Nocebo effect was not negligible in this procedure, although lessfrequent than previously reported, and no special demographic or clinical characteristic could be identified in the nocebo reactors.
The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil
Using sophisticated brain imaging techniques, the authors show that one’s expectation of the success of a pain treatment can markedly influence its effectiveness, and how divergent expectancies alter the analgesic efficacy of a potent opioid in healthy volunteers by using brain imaging.
Nocebo hyperalgesia: how anxiety is turned into pain
Since pain appears to be amplified by anxiety through the activation of cholecystokininergic systems, new therapeutic strategies, such as new cholecentokinin antagonists, can be envisaged whenever pain has an important anxiety component.
Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon?
The burden of this nocebo effect (an adverse side effect that is not a direct result of the specific pharmacological action of the drug) has to be taken into account when managing finasteride sexual side effects.