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Nocebo: Placebos Evil Twin



Most of us are familiar with the term "Placebo." Placebo is defined by Oxford as "a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect." Another simpler definition, "a measure designed merely to calm or please someone."


I believe all of us in one way or another have experienced the psychological benefits of placebo. Whether it was through a medical intervention, an encouraging word from someone, or our own beliefs. When it comes to the placebo effect, my attitude about it has been always a positive one. If it works. If it helped. Then I am all for it.


But it goes to show how powerful our minds are. How powerful our beliefs are. The connection between our brain and the rest of our body is so real that in a way they are not separate. When one gets affected, the other one will also.


Just think about how stress can affect you. Our minds can become so preoccupied that as time goes on our breathing pattern changes. Our muscles begin to tense up. Some of us can then experience headaches or even stomach issues. For some, these issues become chronic. Produces a cycle of psychosomatic symptoms that can have a detrimental affect to our health.


That alone just shows us how powerful that mind body connection really is. So when it comes to a placebo, our positive thoughts or beliefs of any particular intervention can go a long way in helping us feel better.


Enter the evil twin: Nocebo.

The Evil Twin

If a placebo can aid in helping you feel better, then a nocebo effect can do the opposite.


Oxford defines Nocebo as "a detrimental effect on health produced by a psychological or psychosomatic factors such as negative expectations or treatment or prognosis." It's root word comes from the latin word "nocere" which means: to cause harm.


Unfortunately the nocebo effect is also something many of us have experienced. Especially in a therapeutic or clinical setting. Even though it is usually unintentional, many times the harm has been done.


Allow me to give you an example: You go see a Physical Therapist or Massage Therapist. You go in for a shoulder problem. The assessment is so thorough (possibly unnecessarily thorough), and now you are going home with an ankle that can't flex, a hip that is too internally rotated, and a lot of scar tissue on your IT band. On top of that, your muscles are very tight. How do you think you will go home feeling like after hearing all of that? As far as you know, you are broken. Next thing you know, your hip starts to hurt. Your mind is THAT powerul!


This is why I try my best to phrase things to my clients in away that is as accurate as I can be, but also give hope. Everything from the language I use to the tone of my voice can either help or hurt someone. Which is why language is key.


Here's another example. One that really bothers me: "The doctor said it's just old age."

Whether it is something someone told us, or something we tell ourselves, the truth is that that belief can create such a powerful nocebo effect. Saying that it's just old age, is a way of saying that there is nothing we can do, and accept whatever diagnosis or prognosis we are given. Now, I am not saying that as we age things don't slow down or become more difficult, but the reality is that that human body (regardless of age) is highly resilient. It can always adapt. It can always get stronger.


It is one thing I am constantly telling my older clients. That our bodies are meant to be stronger. If you want to be move better, you can. If you want to be more flexible, you can. If you want to be stronger, you can. It's just a matter of having a plan, putting in some effort, and sticking to it.


One last example of a nocebo are medical diagnosis. It's very helpful to know what is the source of our problem. Unfortunately, many times the diagnosis then becomes an identity.


For example, let us say you have back pain and you go get an x-ray. They now tell you that you have "degenerative disc disease." That sounds terrible. "I have a disease?" Now you have a label. Something to identify with. Sadly, many physicians do not take the time to really explain what these things mean. Degenerative disc disease is nothing more than wear and tear of our vertebral discs. MRI scans and studies have shown that we all for the most part have it. The reality is that most people are asymptomatic and experience no problems. The same goes for "herniated discs."


What I see all of the time in my practice are wonderful people that have been now mentally disabled because they were told they had a condition. It's even worse when the only path is medication or surgery. The truth is that less than 2% of all orthopedic or musculoskeletal conditions require any surgical intervention. With the right manual interventions and exercises (maybe even some lifestyle changes) you can not only recover, but even be stronger than you were before.


The point I am trying to make is that words matter. Our thoughts are powerful. Therefore what we are told and what read or listen to can have a healing or a damaging effect. I personally believe that what is even more powerful, is not what others tell us, but what we tell ourselves. What we believe about ourselves.


Therefore, all I want to leave you with is this: You are NOT broken. Your body is strong. It is very resilient. It was designed to adapt. You just have to be willing to work hard at it. The road to recovery is not easy, but it is very well possible. I am always here to help and lay out a plan for you. If it's not with me, it doesn't matter, just don't give up.


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