Nocebo effects are common across medicine. They appear to have profound relevance for the current epidemic of care seeking for back pain—and the tsunami of disability claims for low back pain across industrialized nations. Yet their influence has barely been studied.
From a recent Back Letter article. Are Nocebo Effects Contributing to the International Back Pain Crisis [Subscription necessary; if you don’t have a subscription join the ISCRS so you can get the Back Letter free as a member benefit.] www.clinicalrehabspecialists.org
Identifying potential nocebo effects in the medical management of back pain is easy. Much of the information conveyed to patients and the general public about back pain has a nocebo aspect. Healthcare providers often create the expectation among patients and the general public that they have a serious, life-long degenerative disorder.
Even well-intended advice can be counter-productive and damaging. Throw-away lines delivered in a medical setting can stick with patients—and change the way they think, act, and work:
“Don’t lift anything that weighs more than five pounds.”
“I don’t think you should work with that disc herniation.”
“The vibration of driving may exacerbate your back problems. You may need to change jobs.”
Winfried Häuser and colleagues found 150,000 studies and articles that mentioned placebo effects. After stripping away placebo-controlled drug trials, they were able to identify more than 2200 studies actively addressing placebo effects. (See Häuser W et al., 2012.)
By contrast, they found only 151 publications on the topic of “nocebo.”
Of the publications on nocebo effects, only about 30 were empirical studies. The remainder were editorials, commentaries, letters to the editor, and reviews. To say this is an understudied area is an understatement.
Prior post on the Nocebo.