The nocebo effect: cost-intensive illicit drugs have stronger side effects

Expensive sham drug causes more side effects than beneficial
When patients are taking medicines they may also experience side effects. As German researchers now report, this so-called nocebo effect is exacerbated when the dummy drug is an expensive drug.

Placebos work on various ailments
It has long been recognized that spot drugs, called placebos, can help treat a variety of ailments such as chronic back pain. In addition to the "placebo effect", which is a concept for most people, there is also the little-known "evil twin of the placebo", the so-called "nocebo effect".In this case, dummy medications can also have adverse effects. According to a new study, this effect is exacerbated when the supposed drug is an expensive drug.

drug-free drugs may cause side effects in patients. Researchers now report that this effect is even more pronounced if the putative drug is an expensive drug.(Photo:

Expensive sham drug causes more side effects than cheap

Patients who say a given drug can cause side effects often use it - even if it is a drug-free sham drug.

This so-called nocebo effect is exacerbated when patients receive value information about the putative drug. An expensive sham medication causes more side effects in the test than a cheap one.

scientists from the University Hospital Hamburg-Eppendorf( UKE) have investigated these relationships in a study;Their results have now been published in the journal "Science".

Expectation of Patients
This phenomenon can be attributed to the expectations of the patients, which can even be demonstrated with imaging techniques.

"In anticipatory effects, the modulating pain system is of great importance," said Alexandra Tinnermann, a scientist at the UKE's Institute of Systemic Neuroscience.

"Expectations arising in the frontal brain can influence the processing of painful stimuli in deeper regions of the nervous system, such as the brain stem or spinal cord, through the modulating pain system," explains the expert.

In order to examine the modulating pain system under negative expectations, they have used a new method of functional magnetic resonance imaging( fMRI).

"We found in our study that negative expectations affect three important areas of the modulating pain system - frontal brain, brainstem, and spinal cord."

Placebo and Nocebo Effect
In clinical trials, patients receiving placebo andAre group and therefore have received a drug without active ingredient, often from side effects. These often fit exactly to the possible side effects of the actual drug.

A dummy drug can not only help to improve the symptoms( placebo effect), but also cause the side effects of the drug itself( nocebo effect).

"In our study, we examined how value information about a drug affects the nocebo effect," says scientist Tinnermann.

subjects received a dummy drug without medical drug. To arouse a negative expectation, the subjects were told that the drug can cause side effects that lead to an increased sensation of pain.

In addition to this negative expectation, half of the subjects were informed that the drug was cheap and the other half that it was expensive.

The group that received the expensive sham medication showed a greater nocebo effect - a higher pain sensation - than the group that received the cheap drug.

"The results show that the value of a drug in addition to the negative expectations can affect pain perception;the processing of pains in the spinal cord is also altered by these factors, "says Tinnermann.(ad)

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