Tap into the potentially powerful connection
between the mind and the body.
due to the placebo effect.
Many people, including health
professionals, are less familiar
with the nocebo response. It is the
opposite of the placebo response.
Specifically, people have an
expectation that they will have a
negative health effect and then a
negative effect actually occurs. In
a well-known nocebo experiment,
people were asked to swallow
a liquid and were told that the
liquid would make them vomit.
Even though the liquid was
simply sugar and water, approximately 80% of them vomited.
Nocebo effects also occur
frequently in clinical trials.
Even if they are in the placebo
group, receiving nothing that is
medically active, volunteers may
experience negative effects. On
average, about 25% of people
in trials experience some type
of nocebo response, with the
most common being headaches,
drowsiness and weakness.
A recent review of 100 MS
clinical trials over the past 20 years
found a prominent nocebo effect.
In trials for MS symptoms, such
as fatigue or muscle stiffness, 25%
of people had a nocebo response.
The trials of the disease-modifying
drugs showed the very high nocebo
response of 74%. The earlier
phases of drug testing are associ-
ated with higher nocebo responses
and, overall, nocebo responses
seem to be occurring more frequently in more recent trials.
How do placebo and nocebo
Although not fully understood,
there are thought to be several
important factors. These include
the setting in which the therapy
is provided and the mindset and
attitudes of the clinicians as well
as the people being treated. The
expectation of the person being
treated is especially significant.
Positive expectations are thought
to be a major factor in elicit-
ing the placebo response, while
negative expectations underlie
the nocebo response. Anxiety
and depression also appear to
play a role in nocebo responses.
Important but often forgotten
Despite the fact that placebo
effects are a significant component
of the overall effect of a therapy,
researchers may view them as a
nuisance. They are unpredictable
and cannot be easily analyzed with
scientific and mathematical thinking. Although placebo responses
are mysterious, they do reflect
improvements—and thus may
provide insights into the nature
of healing and some practical
guidelines on managing chronic
diseases like MS.
Because it is essential to support
trust between the clinician and
patient, it is generally considered
unethical for clinicians to provide placebos to their patients.
However, it is possible—and
probably quite important—for
people with MS to work with
their clinicians to cultivate their
placebo responses and minimize
the nocebo effects. This strategy
aims to develop hope, optimism
and empowerment, and to identify and treat negative feelings.
The overall approach extends
significantly beyond the health-care setting.
• Health care: Try to feel
positive and confident about
your medical therapies. If possible, seek out health-care professionals who evoke your trust.
These would be professionals
who are reassuring, straightforward, provide personal encouragement and respect the individual values of their patients.
• Social network: Optimize
your social support. There will
some relatives and friends who
induce more of a nocebo effect
for you. It’s important to cultivate the people who are helpful
and to minimize contact with
• Spirituality and prayer: