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Herniated Disc Nocebo
What is the Effect?Nocebo is the Latin word meaning “I will harm”. It is the exact opposite in scope as the placebo effect. In medicine, placebo describes a treatment which will enact a positive change or even a complete cure, even though it has no actual merit or healing abilities. It works completely through the power of suggestion and psychological influence. In essence, if the patient has a strong belief that the treatment will work, then they are likely to enjoy a good result from utilizing that particular therapy option. Nocebo has exactly the opposite effect on a struggling patient. Instead of helping a patient, a nocebo will actually cause increased symptoms or even initiate symptoms when none were experienced before.In terms of back pain, we see the influence of the nocebo mostly in the diagnostic process. A patient is told they have a particular spinal condition and immediately suffers increased symptoms which are likely to last long term. Many times, a spinal condition is found by accident (such as when testing for an unrelated condition) and the patient has never suffered any pain from it in the past. It is common for these patients to begin to experience pain and other symptoms after the condition is discovered and diagnosed. How Does a Herniated Disc Nocebo Work?The herniated disc nocebo effect can be increased, decreased or avoided completely, depending on the bedside manner of the diagnosing physician. If the patient is made to feel like they are in serious jeopardy by the diagnosis of a herniated disc, they are likely to suffer a serious nocebo reaction. If they are not reassured and given at least a good chance of recovering from the condition, they are likely to suffer some nocebo reaction. If they are reassured and provided the facts about a mostly innocent and common spinal condition, they are unlikely to suffer any nocebo reaction at all.The choice of words used by the diagnosing doctor is crucial. If the diagnostic picture is one of doom, gloom and fear, the patient will naturally react negatively and might suffer an immediate downward spiral in their physical and psychological conditions. If the doctor chooses to tell the patient that their spine is basically normal and their condition is common and rarely the source of chronic pain, they are likely to recover completely in a normal time frame. The power of the nocebo effect is devastating and can even be used as a purposeful weapon by some greedy care providers. My Experience with Herniated Disc NoceboThroughout my back pain journey, I suffered one nocebo after another, from even the best intentioned doctors and chiropractors. When I was first diagnosed with degenerative disc disease and scoliosis by my first chiropractor, the words he used put me immediately into a sense of panic and dread for my future. Obviously, this guy had every intention of placing me in ongoing care to fatten his bank account. His treatments never cured anything and definitely contributed to the apprehension I suffered my entire adult life. Doing this to a 16 year old is nothing short of criminal and I wish I knew then what I know now… The situation certainly would have been handled differently on my end…When I was diagnosed with herniated discs, it was as if I was condemned to death. My new chiropractor made more horrific predictions, but not as gloomy as the original guy. Regardless, I did get worse year by year and began to really fear for my future. As my back pain suffering continued, I was given a host of dire predictions by a variety of care providers due to my spinal condition. Several doctors told me I would definitely need disc surgery and a few predicted serious disability in my future. How are these inaccurate and ridiculous diagnoses supposed to ever allow a person to recover from anything? I did have one good orthopedic surgeon who basically told me my spine was all messed up, but did not think it would get worse for me. This guy seemed to take the entire degeneration thing in complete stride and told me to avoid surgery. Thanks for at least that much, doc. I do appreciate it… Finally, I met Dr. John Sarno, the man who actually taught me about nocebo. He was completely unconcerned by my DDD and herniated discs, as well as the 18 years I spent suffering horrible pain. He was cool as could be actually. He simply said, “You have tension myositis syndrome and you will be fine.” FINE? Wow, that sounds good to me!!! I was amazed, but not surprised. By this time, I was already feeling better from reading his books daily and was basically free of the pain before even going to see Dr. Sarno in person. The best part about it was… HE WAS RIGHT! I am fine. Great, actually. Pain free. Imagine how I feel when I look back on all those other doctors who contributed to my wasting 18 years of life in horrible pain. I will never forget the power of the nocebo effect and I urge you to do the same… 6/28/08 Revised 12/9/09
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