The nocebo effect : a clinicians guide

Data-Franco, Joao and Berk, Michael 2013, The nocebo effect : a clinicians guide, Australian and New Zealand journal of psychiatry, vol. 47, no. 7, pp. 617-623, doi: 10.1177/0004867412464717.

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Title The nocebo effect : a clinicians guide
Author(s) Data-Franco, Joao
Berk, MichaelORCID iD for Berk, Michael
Journal name Australian and New Zealand journal of psychiatry
Volume number 47
Issue number 7
Start page 617
End page 623
Total pages 7
Publisher Sage Publications
Place of publication London, England
Publication date 2013
ISSN 0004-8674
Keyword(s) Nocebo
treatment outcomes
adverse effects
Summary Objective: This paper aims to provide an overview on the nocebo effect, focusing on recognition — its phenomenology, at-risk demographic profiles, clinical situations and personality factors, as well as discriminating somatic symptoms in the general population from treatment-related adverse effects. Lastly, the paper addresses available evidence-based strategies for management and minimisation of the nocebo effect.

Method: Data for this paper were identified by searching PubMed using the search terms "nocebo" and “nocebo effect”, augmented by a manual search of the references of the key papers and the related literature.

Results: The nocebo effect refers to non-pharmacodynamic, harmful or undesirable effects occurring after inactive treatment, a phenomenon that also occurs in the context of active therapy. Known drivers include classical conditioning and negative expectations concerning treatment. Recent meta-analyses have reported a considerable prevalence, ranging from 18% in the symptomatic treatment of migraine, to more than 74% in multiple sclerosis. Recognition of the nocebo-driven adverse effects presents a challenge, especially because of its non-specific nature and the similarity to the active medication’s expected profile. Traits such as neuroticism, pessimism and type A personalities may predispose individuals to this phenomenon. Clinical management of the nocebo effect includes awareness and recognition, changing the manner of disclosure of potential drug-related adverse effects, shaping patients’ expectations and enhancing the treatment alliance.

Conclusion: The nocebo effect is a common, clinically significant, yet covert driver of clinical outcomes. Increased awareness of its features, as well as knowledge of strategies on how to manage it, are fundamental so that clinicians can mitigate its impact on clinical practice.
Language eng
DOI 10.1177/0004867412464717
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Sage publishers
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Document type: Journal Article
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School of Medicine
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Created: Thu, 24 Jan 2013, 13:54:35 EST by Jane Moschetti

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