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Pain and the placebo and nacebo effects

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Pain and the Placebo and Nacebo effects


I have written about many studies where there has been a strong placebo effect, the power of positive thought affecting the outcome of a result, but have you heard of the power of the ‘nacebo’ effect.


It’s well documented. Even Shakespeare knew about it over 400 yrs ago. To quote the bard from hamlet ‘there is nothing either good or bad, but thinking makes it so’, or lets quote Jesus ‘as you think, ye shall be’. The power in your thinking has great ramifications, both good and bad. Another quote I love is ‘we become what we think about all day long’. And from Dr. Wayne Dyer ‘you’ll see it when you believe it’. And my personal favourite ‘wherever I go, there I am’. Your thoughts can be your greatest assets or your greatest enemies and when it comes to healing, your health and your wellbeing this is extremely relevant and unbelievably important.

In a study done 7 years ago, researchers discovered that women who believed that they were prone to coronary disease were 4 times more likely to die from it compared to women with similar risk factors but who didn’t hold the same fatalistic viewpoints. Four times more likely to die because of their beliefs! Welcome to the nacebo effect.

The placebo effect refers to the benefits people have when they shouldn’t have any benefits. An example of this is when they give patients in studies sugar pills instead of the real medication without the person knowing and it makes them better. Another example is sham acupuncture where they put needles in areas where there is no known acupoint and the persons’ condition improves. The opposite of the placebo is the nacebo where the person presumes the worst in regards to their health and that is exactly what they get.

According to Dr. Arthur Barsky who is a psychologist at the Brigham and women’s hospital in Boston, he says that these people firmly believe, in fact they are convinced that something will go wrong as it invariably does. It is a self fulfilling prophecy. Dr. Barsky wrote a paper in the journal of the American medical association asking his peers to be very mindful of the nocebo effect with regards to their patients.

Another powerful nocebo effect is voodoo and witchdoctors. People die simply because they have been put under a spell, a curse or a hex and they are firmly convinced in the power of that person who put the curse on them. They are literally scared to death. The word nocebo is Latin and means ‘I will harm’.

According to Dr Irving kirsch who is a psychologist at the university of Connecticut in Storrs and specialises in the area of ‘peoples thoughts and the outcomes that are produced because of them’, says that nocebos produce a physical effect when there is nothing physically wrong with the person. It really is mind over matter.

A Harvard professor, Mr Herbert Benson says that surgeons are extremely cautious when dealing with patients that have needed surgery and wanted to die to be with their family who had passed away before them. These patients no longer wanted to live. The research done in regards to these types of patients has shown that nearly every single one of them died in surgery!

Another classic example of the nocebo effect happened 10 years ago in the United States. The researchers were doing studies on a new drug for blood thinning in heart patients in three separate hospitals. At two of the hospitals the pharmaceutical representatives told the doctors to inform their patients that there were side effects of the drugs that could produce gastrointestinal problems. At the other hospital they accidentally forgot to tell them.

When researchers reviewed the data, they found an amazing result: Those warned about the gastrointestinal problems were almost three times as likely to have the side effect. Though the evidence of actual stomach damage such as ulcers was the same for all three groups only those that knew about the side effects felt pain.

Another classic study was shown by a research group who made an allergy sufferer start wheezing and sniffling by showing him an artificial rose. In the 1980s, they had 34 students in a room and the students were told that they would have an electric current passed through their heads. They were told not to worry as there would be no lasting effects. However, they were told that they may experience a headache after the current had been given to them. No current was ever used but 70% of the students suffered headaches.

Over the years I have seen a few clients who I believe did not want to get better and so they did not. Their symptoms are very real for them and they generally have seen practitioner after practitioner but to no avail. Quite often they have underlying reasons for remaining unwell. One of the major reasons is to remain in what I call victim mode. This is a form of attention seeking behavior where you can receive sympathy from others who are worried about you and all of your physical ailments.  If you get better you stop having people sympathizing with you and therefore you remain unwell and suffering in pain.

Dr Barsky has spent many years researching these kinds of people and has in fact written a profile of people who fall into this category and are likely to experience a nocebo effect. He says it’s normally a person that he sees who has a history of vague, difficult to diagnose symptoms and complaints. These people are almost certain that any types of therapy or medications are going to help them and that is generally exactly what happens.