Welcome to the second season of The Patient Whisperers’ podcast, I’m Marc Sacco and I’m Roger Woods and we are your guides on the entertaining and informative journey into the world of...Verbal Medicine, The Language of Healing. Today, we’re talking about the effects of negative language on patient recovery and the health nocebos used by every healthcare professional and what we can do to stop doing it.
The study cited: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5639717/
Nocebo effects in clinical studies: hints for pain therapy
Regine Klinger, Maxie Blasini, Julia Schmitz, and Luana Colloca
Selected passages:
Neurobiological studies have revealed great similarities between the molecular basis of drug action and the related placebo responses, suggesting that a placebo can partially replace the verum and enhance its effects.
For example, a pioneering study reported that of 15 patients receiving lumbar puncture who were told to expect a headache afterward, 7 experienced headaches. By contrast, of the 13 patients who were not warned about the possibility to have a headache, none experienced such side effects. The authors concluded that “patients should not be told to expect a headache, as this may be a self-fulfilling prophecy.”
Also, in a randomized controlled study, the effects of verbal suggestions have been investigated during the administration of epidural anesthesia for labor pain. Women were informed about the procedure using 2 styles of framing: “We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure” or “You are going to feel a big bee sting; this is the worst part of the procedure.” Women who were informed through the positive-framing technique reported significantly less pain than those informed through the negative-framing style for the same procedure.
Nocebo effects could be prompted by knowledge of adverse effects related to the use of pharmacological drugs, and could potentially last for long periods of time. A study performed by Mondaini et al37 investigated the sexual side effects associated with treatment of benign prostatic hyperplasia with finasteride (5 mg) by informing patients through 2 different disclosure styles. Randomization of patients into the 2 groups occurred after the treatment was described as having proven efficacy for managing benign prostatic hyperplasia. One of the groups was provided with information regarding uncommon but potential sexual side effects, specifically naming erectile dysfunction, decreased libido and problems with ejaculation, while the other group was not informed about such effects. At 6- and 12-month follow-ups, a significant difference between reported sexual side effects was observed between the 2 disclosure groups. Of the group informed about the sexual side effects, 43.6% reported sexual dysfunction compared to 15.3% in the noninformed group.
Informed consent practices may be inadvertently inducing nocebo effects by triggering negative expectancies through the explanation of possible adverse effects related to medication use. Thus, it calls for a need to balance the ethical principles of protecting the patient's autonomy and right-to-know, with the poss