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February 8, 2012

Nocebo Effects, Patient-Clinician Communication, and Therapeutic Outcomes

Author Affiliations

Author Affiliations: National Center for Complementary and Alternative Medicine, and Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland (Dr Colloca); and University of Sydney Pain Management and Research Institute, Royal North Shore Hospital, St Leonards, New South Wales, Australia (Mr Finniss).

JAMA. 2012;307(6):567-568. doi:10.1001/jama.2012.115

Nocebo effects are adverse events produced by negative expectations and represent the negative side of placebo effects. It is now recognized that nocebo effects exist and operate during routine treatments, negatively affecting clinical outcomes even when placebos are not administered. The nocebo effects and placebo effects are the direct result of the psychosocial context or therapeutic environment on a patient's mind, brain, and body. Both phenomena can be produced by multiple factors, such as verbal suggestions and past experience.1 In the case of nocebo effects, negative information and prior unsuccessful therapies may be particularly important in mediating undesirable outcomes to routine therapy. Therefore, consideration of nocebo effects in the context of patient-clinician communication and disclosure in routine practice may be valuable in both minimizing the nocebo component of a given therapy and improving outcomes.

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