What is a Placebo?

• A placebo is a widely recognized phenomenon in medicine that is known for having positive physical or psychological changes that occur after taking medication without an ingredient such as a sugar pill. This can also be done with sham treatments such as simulated surgery (Bingel et al., 2022).

What is a Nocebo?

• A nocebo is the opposite of a placebo. It will have negative physical or psychological changes that occur after taking a sugar pill or receiving a sham treatment due to negative beliefs and expectations of the patient.

Who do they work on?

• Placebo and nocebo effects have been seen in patients with Parkinson’s, Huntington’s, and Alzheimer’s diseases, restless leg syndrome, tics, essential tremors, dystonia, functional movement disorders, neuropathic pain, headaches, migraines, amyotrophic lateral sclerosis, myasthenia gravis, multiple sclerosis, and epilepsy (Mariani et al., 2020).

• Placebos can work on different body systems such as the nervous system, immune system, digestive system, and respiratory system (Bingel et al., 2022).

How do they work?

• The science behind placebos and nocebos is not fully understood.

• We know that people have expectations regarding treatments offered by healthcare professionals. These expectations can be hopeful or fearful and may influence the outcome of the treatment.

• What influences expectations?

• Previous experiences with treatments

• Hearing about other patients’ experiences with treatments

• The doctor-patient relationship

• Culture and society

• Practitioner qualities- compassionate, competent, empathetic, and friendliness (Blasini et al., 2018)

• Believing that a specific treatment will or will not work activates certain mechanisms within the body. For example, if a patient expects a treatment to decrease their pain, endogenous opioids (opioids made within the body) are released and will decrease pain (Bingel et al., 2022). This is known as the “internal pharmacy”. 

What does this mean for healthcare?

• Ideally, healthcare professionals will recognize the value of taking the time to build trust with patients and explain the benefits and objectives of a treatment.

• Due to ethical reasons, it is not allowed within the healthcare community to administer placebos outside of clinical trials without the patient’s knowledge.

• Research has been done on “Open-label placebos” which is when a patient knows they are taking a pill without an active ingredient. Surprisingly, open-label placebos can still support treatment and healing (Bingel et al., 2022).

Sources

Hartmann, H., & Bingel, U. (2023, May 15). Placebo and nocebo effects: The importance of treatment expectations and patient-physician interaction for treatment outcomes. International Association for the Study of Pain (IASP). https://www.iasp-pain.org/resources/fact-sheets/placebo-and-nocebo-effects-the-importance-of-treatment-expectations-and-patient-physician-interaction-for-treatment-outcomes/ 

Blasini, M., Peiris, N., Wright, T., & Colloca, L. (2018). The Role of Patient-Practitioner Relationships in Placebo and Nocebo Phenomena. International review of neurobiology, 139, 211–231. https://doi.org/10.1016/bs.irn.2018.07.033

Mariani, L. L., & Corvol, J. C. (2020). Maximizing placebo response in neurological clinical practice. International review of neurobiology, 153, 71–101. https://doi.org/10.1016/bs.irn.2020.04.003

Požgain, I., Požgain, Z., & Degmečić, D. (2014). Placebo and nocebo effect: a mini-review. Psychiatria Danubina, 26(2), 100–107.