The Placebo and Nocebo Phenomena: Their Clinical Management and Impact on Treatment Outcomes

Abstract

Placebo and nocebo effects occur frequently and are clinically significant but are underrecognized in clinical practice. Physicians should be able to recognize these phenomena and master tactics on how to manage these effects to enhance the quality of clinical practice.

Consensus report: clinical recommendations for the prevention and management of the nocebo effect in biosimilar‐treated IBD patients

“…It should provide the most transparency with the least potential harm, applying the principles of positive framing. This involves drawing attention to benefits rather than drawbacks, without refraining from delivering the necessary information . Positive framing has shown to improve subjective patients' experiences following medical therapy .…”

Incidence and characteristics of the nocebo response from meta‐analyses of the placebo arms of clinical trials of olanzapine for bipolar disorder

“…Administering an essentially inert substance to a patient or a study participant can influence clinical outcomes such as symptom severity, including improvement or worsening, and may elicit treatment‐emergent adverse events(TEAEs). These phenomena, known as the placebo (improvement) or nocebo (worsening or adverse events) effects, occur commonly and are of varying intensity, are challenging to predict, and may be difficult or impossible to distinguish from the natural progression of some illnesses or naturally occurring adverse events . This concept has been extended to include not only inert substances, but also non‐inert or pharmacologically active substances that are not considered to be effective for the index symptoms being treated …”

“…occurring adverse events. 1,2 This concept has been extended to include not only inert substances, but also non-inert or pharmacologically active substances that are not considered to be effective for the index symptoms being treated. 3 Nocebo and placebo responses have been attributed to expectancy, conditioning, learning, memory, motivation, somatic focus, reward, anxiety reduction, and "placebo by proxy" induced by clinician and family members.…”

“…3 Nocebo and placebo responses have been attributed to expectancy, conditioning, learning, memory, motivation, somatic focus, reward, anxiety reduction, and "placebo by proxy" induced by clinician and family members. 2 Conditioning was used to induce a nocebo response in one study 4 and to minimize it using counterconditioning in another. 5 Nocebo has been associated with neurobiological factors including decreased dopamine and opioid neurotransmission.…”

Placebo and nocebo phenomena from the perspective of evidence based and person centered medicine

“…For proper understanding of placebo and nocebo phenomena in pharmacology it is of great importance to be familiar with quite a number of explanatory models which can be identifi ed in scientifi c literature (Table 2) In order to benefi t from better understanding of placebo and nocebo phenomena, it is important to establish a culture in the daily medical practice, in which physicians are familiar with the potential of these mechanisms and master strategies on how to manage these phenomena to increase the quality of research and clinical practice [34,35]. Goal-oriented utilization of placebo responses may contribute to overall drug treatment eff ectiveness while having in Placebo and nocebo might be considered as the personal responses to any kind of treatment, so they are very important phenomena from the perspective of the personcentered medicine.…”