This time, I'd like to talk about the placebo effect and the nocebo effect.
What is your impression when you hear the words "placebo" and "nocebo" effect?
I only have the impression that they are sham treatments used in comparison groups in research, etc. I do not have a positive impression of them.
I don't have a positive impression of it. In the public mind, pseudo-medicine and pseudo-pharmaceuticals due to the placebo effect are sometimes used as commercial products to make money, rather than being related to treatment.
Here is a paper that studies the placebo/nocebo effect on such treatments.
Contents of the study
The placebo and nocebo effects embody psychoneurobiological phenomena in which behavioral, neurophysiological, perceptual and cognitive changes occur during therapeutic encounters in a medical context.
The placebo effect is produced by positive health care contexts.
The nocebo effect, on the other hand, is the result of a negative health care context.
Historically, placebo, nocebo, and context-related effects were considered confounding factors by clinicians and researchers.
Over the past two decades, this attitude has begun to change and there is a better understanding of the value of these effects.
Despite the growing interest, knowledge and awareness of triggering placebo and nocebo effects using a health care context is currently limited and heterogeneous among physical therapists, reducing translational value in the physical therapy field.
As an objective, placebo, nocebo, and context-related effects will be presented in the following ways
1: Presenting psychological models.
2: Explaining their neurophysiological mechanisms
3: Highlighting their implications for the physical therapy profession
4: Trace lines for future research
In conclusion, several psychological mechanisms have been implicated in placebo, nocebo, and context-related effects.
Expectations
Learning processes (classical conditioning and observational learning)
Reinforced expectations
Attitudes
Personality traits
These are included.
Neurophysiological mechanisms include primarily endogenous opioids, endogenous cannabinoids, and the dopaminergic system.
Neuroimaging studies have confirmed the involvement of various brain regions, including the dorsolateral prefrontal cortex, rostral anterior cingulate cortex, periaqueductal gray matter, and the dorsal horn of the spine.
From a clinical perspective, the manipulation of health care situations with the best evidence-based treatments represents an opportunity to avoid the nocebo effect, which causes the placebo effect and respects ethical codes of conduct.
From a management perspective, stakeholders, organizations and governments need to encourage the evaluation of health care situations with the aim of improving the quality of physiotherapy services.
From an educational perspective, placebo and nocebo effects are professional topics that should be integrated into university programs in the health and medical professions.
From a research perspective, the control of placebo, nocebo, and context-related effects provides an opportunity to better measure the impact of physical therapy on a variety of outcomes and a variety of conditions through primary research.
Explanation
The placebo effect is the medical effect that results from a positive intervention.
The nocebo effect is the medical effect of a negative intervention.
Physical therapists are often affected by these effects because of the close relationship they have with their patients among their many medical qualifications.
Some of the factors that have been described are
1: The physical therapist's expertise, mindset, and appearance
2: Patient's beliefs, experiences, and expectations about the disease and treatment
3: Words, gestures, and behaviors presented in the physical therapist-patient relationship during the therapeutic encounter.
4: Rituals, invasiveness, and apparent application of interventions
5: Furniture, architectural design, and overall impression of the clinic
These contextual factors directly affect the health-related outcomes of patients and have been proposed as largely responsible for treatment effectiveness.
As an example, if related to a positive verbal suggestion of a physical therapist, the same treatment can reduce pain and increase the patient's physical fitness.
Whereas when associated with an uncertain verbal suggestion, the pain and strength may worsen.
Although described as placebo or nocebo effect, and not necessarily something that is explained or educated about, there is a need for us as a medical service industry to understand that these phenomena are occurring.
Rossettini G, Camerone EM, Carlino E, Benedetti F, Testa M. Context matters: the psychoneurobiological determinants of placebo, nocebo and context- related effects in physiotherapy. related effects in physiotherapy. Arch Physiother. 2020;10:11. Published 2020 Jun 11. doi:10.1186/s40945-020-00082-y
Conclusion
This study analyzed the placebo and nocebo effects from many angles.
As mentioned in the text, if it is performed desirably, it will have a good effect, but if it is not, it may have a different result.
In other words, the psychological influence on the patient's perception of abnormalities in the body seems to be significant, which may explain why people continue to cling to things that have not been proven to work.
