The "Journal of the American Medical Association" (JAMA) has just published online an opinion article on the role of "nocebo effects" in medical treatment and how to minimize its effect. The article is available for free here: http://jama.jamanetwork.com/article.aspx?articleID=1887491&utm_source=Silverchair%20Information%20Systems&utm_medium=email&utm_campaign=JAMA%3AOnlineFirst07%2F07%2F2014
The reference for the article is: Bingel U, For the Placebo Competence Team. Avoiding Nocebo Effects to Optimize Treatment Outcome. JAMA. Published online July 07, 2014. doi:10.1001/jama.2014.8342. While placebo effects are associated with "positive" results or enhancing treatment effects, nocebo effects are associated with "negative side effects" or in contemporary terms "adverse effects". It is now recognized that nocebo effects can arise from negative expectations that are generated in patient/person receiving treatment. The power of nocebo is described in the following quote from the article: |Negative expectations not only determine the occurrence of |unwanted adverse effects but can affect the therapeutic efficacy |of the drug. A pharmacological study using functional magnetic |resonance imaging showed that negative treatment expectancy |abolished the analgesic effect of the potent ยต-opioid remifentanil |at the behavioral and neural level.2 Similarly, a recent study of |acute migraine treatment revealed that falsely labeling the |5HT1B/1D agonist rizatriptan as placebo significantly reduced its |efficacy.3 Observations from clinical crossover trials and |experimental evidence indicate that negative expectations or |prior experience transfer over time, and treatment can hamper |the effect of subsequent treatment.4 | |These negative effects on treatment efficacy and tolerability |induced or driven by psychological factors are referred to as |nocebo effects. This understanding makes the statement "it's all in your head" take on new significance because even if psychological factors are involved, that does not mean you don't have biological consequences. What is perhaps most surprising is one tactic that is suggested to reduce nocebo effects. Consider the following quote: |In addition to these strategies, empathic patient-physician |communication is known to help prevent unwanted adverse |effects. For instance, medical jargon is likely to cause |misunderstandings and trigger fear in patients (e.g., "Screening |for tumors was negative"). A patient-centered communication |style is therefore required when explaining diagnostic procedures, |their results, and the rationale and implementation of any |intervention. Knowledge of nocebo effects and the importance |of communication competence for health outcomes should be |reflected in the curricula of future health care professionals. The article provides a box which contains a number of things to do to reduce nocebo effects but the one that stands out, at least for me, is: Adapt an authentic and empathic communication style. I've had to deal with a number of M.D.s over the course of my life and I have always been surprised by how many had poor communication skills as well as probably would have scored low on a measure of "emotional intelligence" (indeed, I've wanted to punch out a couple of them for their A-holish attitude). It is about time that concerns about communication style and related issues were taken seriously, especially since they can apparently reduce the degree of efficacy of their treatment. Anyway, this article may be relevant to a number of classes, from health psychology to psychology of language (on the nature of conversations) to courses involving neuroscience. -Mike Palij New York University m...@nyu.edu --- You are currently subscribed to tips as: arch...@jab.org. To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13090.68da6e6e5325aa33287ff385b70df5d5&n=T&l=tips&o=37499 or send a blank email to leave-37499-13090.68da6e6e5325aa33287ff385b70df...@fsulist.frostburg.edu
