The Nocebo effect: how you think about your injury and pain affects your outcomes

The Nocebo effect is basically the opposite of the placebo effect which occurs when an inert or seemingly inactive treatment is applied and a person has a positive outcome. The nocebo effect or response is when a person has a negative response to the potential negative outcomes of a treatment.

An example of the Nocebo effect is when a patient is in a drug trial and given placebo medicine but told it may have side effects the patient then has side effects even though they were never given medication. Studies show that around 20% of people in drug trials will experience a Nocebo response.

An example of the placebo effect, which most people know much better, is that people have these same sugar pills but have positive outcomes.

This can also happen within musculoskeletal injuries. If you don’t think that the treatment is going to work and therefore don’t put in any effort with your own self release work, exercises and relaxation techniques then you will likely not have as good an outcome as someone who is really positive about their healing and puts in lots of effort with their own at home exercise regime.

So the take away here is if you believe the treatment you are undertaking isn’t going to help you then it likely won’t. If you believe it will, then it likely will. This may seem a bit woo woo but this is based in recent science and is a well established concept these days. The placebo effect has helped many people overcome pain and injury. A simple example is that paracetamol (Panadol) has no evidence for helping lower back pain above placebo in clinical, double blind trials, yet many people take paracetamol for lower back pain and it takes their pain away. Crazy right?

And to get a little bigger picture… Generally the way you think is influencing everything in your life. If you have a negative outlook on life then it is more likely that you will have negative outcomes, this is the nocebo effect. If you think, “well life is shit and I’m supposed to feel pain” then you will. If you think “I can do this and get out of pain and life a healthy pain free life” and really mean it and take steps towards living this truth, then you likely will have this outcome.

Obviously there are many illnesses and diseases where positive thinking won't cure the disease, but it may make the way you are living more tolerable and liveable.

References and further reading:

Sydney Uni - You know medicine's placebo effect. Now meet the nocebo effect: https://www.sydney.edu.au/news-opinion/news/2019/11/20/you-know-medicines-placebo-effect-now-meet-the-nocebo-effect.html

WebMD - Is the Nocebo Effect hurting your health?: https://www.webmd.com/balance/features/is-the-nocebo-effect-hurting-your-health