Mind Over Matter: the Placebo/Nocebo Effects
The first time I heard of the “placebo effect” was way back in the 1970s on M.A.S.H., a TV sitcom about the staff of a field hospital in war-torn Korea. The episode portrayed it perfectly: when the fighting delayed the delivery of morphine to relieve the pain of the wounded soldiers at the hospital, the doctors, desperate to help their patients, reluctantly decided to bet on the power of suggestion: the placebo effect. They gave their patients carefully scheduled doses of sugar pills, telling them that they were receiving strong, opioid analgesics.
In all but a few of the men, it worked—at least until the real analgesics arrived.
So. In Latin, placebo means “I shall please.” That a placebo—the belief that something will make you feel better, so it does—can and often does work is pretty well known. Studies have shown its success again and again. And sure, if we find out we’ve been deceived, particularly by a doctor, we’ll be angry. Rightfully so. But there’s really no arguing the often positive outcome.
But what about the nocebo effect? It’s basically the opposite of the placebo effect. Instead of “I shall please,” the word nocebo means “I shall harm.” Not much ambiguity there.
Let’s go back to those M.A.S.H. doctors. What if they told their patients the pills they’d just taken were the wrong ones; that they’d given them medicine that might make them nauseous by accident? Chances are good that the soldiers would start to feel sick to their stomachs in addition to their ongoing pain from their wounds.
And what does this interesting discussion have to do with rheumatoid disease?
First, most of us have experienced the power of nocebo when we read about the possible side effects of the drugs we’re prescribed. Learning that your RD drug, which might slow or even stop the progression of your disease and reduce your symptoms, might also make you sick in other ways is daunting. Who among us hasn’t wondered, when we get a rash or feel nauseated, if our RD drug might be causing it?
The fact is that most drug side effects are rare, affecting very small percentages of those who take them. The government, however, requires drug companies to report all adverse reactions experienced by test subjects during clinical trials—even when the subject reporting them was taking not the drug, but a placebo.
That doesn’t mean that there aren’t real issues with the side effects of some drugs. But overall, most people aren’t adversely affected by them.
How I perceive pain and illness makes a difference in how I actually feel, and I’m not alone. Here’s an example. In the early years following my diagnosis, a single sharp twinge in one of my joints was often a harbinger of serious trouble to come. Soon after that twinge the joint would begin hurting with each movement. That would progress to throbbing and aching abominably, even at rest. As time passed the flare continued to intensify, sometimes to agonizing, disabling proportions. The pain was stunning. And it usually lasted from two to five days before easing. Working and taking care of my other responsibilities as a wife, mother, and homemaker were often impossible until the flare eased.
Is it any wonder that a twinging joint came to signal impending misery and disability to me? And even after all these years, it still does. A joint twinges and I’m instantly fearful. Even though I rarely experience flares like that anymore, my mind instantly flashes back to those bad old times, complete with vivid memories of long, sleepless nights and days filled with pain. I start thinking “oh, no … oh, no …”
For me, those sudden twinges are like a nocebo. My mind goes into full catastrophe mode—at least, until I force myself to calm down. I know these twinges rarely mean disaster anymore. And, I know that even if one does progress into a full-blown flare, I can handle it.
How we think definitely influences how we feel. By preferring positive to negative thoughts, and by reminding myself that the bad times are in the past, and how tough I really am, I can improve my emotional reaction to a new flare. And by doing that, sometimes I can lessen my physical reaction, as well.
Have you experienced the placebo effect? How about the nocebo effect?
On a scale of 1(low) to 5(high), how difficult is it for you to talk about having RA?