Negative “Nocebo” Response Even More Powerful Than “Placebo” Response?

Rob Wipond
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Doctors who intentionally or unintentionally communicate to patients that they do not believe or understand them could be causing patients’ symptoms to worsen, suggests an article in the American Journal of Medicine.

The researchers from the universities of Exeter and Southampton “recorded and analysed consultations at a pain management clinic involving five women with chronic wide-spread pain,” stated a press release about the study. “During subsequent interviews patients reported feeling dismissed and disbelieved by healthcare providers, encountering providers who did not invest in them or show insight into their condition… Patients described feeling hopeless and angry after invalidating consultations, feeling an increased need to justify their condition or to avoid particular doctors or treatment altogether.”

These findings built on a connected study by the researchers showing that people who feel “disbelieved” can develop “increased anger and stress,” and that this negative effect on their overall well-being “was much more powerful than positive reinforcement, the well-known “placebo” effect,” stated the press release.

One of the researchers commented that problems often even emerge unintentionally in physicians’ misunderstanding of the relationships between physical and psychological problems: “This study is really about humanity in healthcare. We have found that patients perceive a lack of empathy and understanding, even when the doctor is trying to be comforting. Comments such as ‘there’s no physiological reason that you’re experiencing pain’ seek to reassure, but can be perceived as patronising or disbelieving.””

Negative patient-doctor communication could worsen symptoms (University of Exeter press release on ScienceDaily, January 28, 2015)

Greville-Harris, Maddy, and Paul Dieppe. “Bad Is More Powerful than Good: The Nocebo Response in Medical Consultations.” The American Journal of Medicine 128, no. 2 (February 1, 2015): 126–29. doi:10.1016/j.amjmed.2014.08.031. (Abstract)

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Rob Wipond
Rob Wipond is a Victoria, British Columbia-based freelance journalist who has been writing on mental health issues for fifteen years. His research has particularly focused on the interfaces between psychiatry, the justice system, and civil rights. His articles have been nominated for three Canadian National Magazine Awards, six Western Magazine Awards, and four Jack Webster Awards for journalism. He can be contacted through his website.

4 COMMENTS

  1. ‘there’s no physiological reason that you’re experiencing pain’: when doctors cannot find (or are not interested in finding) the underlying reasons why there is pain or other problems, they often resort to psych consult. A psych Dx confirms that there is no “real” pain or problem, just a person who is exaggerating, imagining, hallucinating, malingering, manipulating, etc.

    • Oh, yeah. I discovered I had MS when I couldn’t stand or walk, after suffering symptoms for years, but not telling a doctor about my lack of energy because I did not want to be sent to a psychiatrist for “depression”. I didn’t know what it was, but I knew damned well it was physiological. After I was diagnosed I asked what I was feeling, because if it was “tired” I’d never been tired a day in my life. It was fatigue. It’s real. It’s physiological.

      There is a certain amount of vigilance about pain meds that may be justified, but women often have “complaints” in the man’s world of medicine that aren’t worthy of professional consideration because women just bitch all the time, right?

  2. “This study is really about humanity in healthcare.”
    Yeah, a little bit of humanity and empathy could do wonders. Actually listening to the patient…
    I’m dealing with chronic pain (a consequence of wonders of psychiatric treatment) and any insight into what might be causing it and how to treat it comes from friends, self-observation and “Dr Google”. The professionals are close to useless and yeah, of course they tried to tell me it’s in my head.

  3. Terrible doctors at Oregon State Hospital frame each patients ‘side effect’ complaints to be part of mental disorder or ‘faking it’. These cold hearted f***s cover their tracks knowing no outside doctor is skilled enough or even available to patients to contest this barbaric crap before serious mutilation and injury is too late.

    No doctor within the facility will go against another doctor either. One who tried a few years ago was fired and retaliated against. This protects them from liability for such mistakes.

    I saw people get NMS, psychosis, speech disturbances, and dystonia, jaundice and other problems – doctors will never admit they caused it, people have die too. A girl I was told about went from fully functioning to crapping her pants and being unable to even speak, normal once entering, brain dead and incognito once her 10 years was up..

    http://www.obamasweapon.com