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2scoops
USA
386 Posts |
 Posted - 10/11/2007 : 19:26:35
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http://curezone.com/art/read.asp?ID=142&db=1&C0=14
By Brian Reid
Special to The Washington Post www.washingtonpost.com
Tuesday, April 30, 2002; Page HE01
Ten years ago, researchers stumbled onto a striking finding: Women who believed that they were prone to heart disease were nearly four times as likely to die as women with similar risk factors who didn't hold such fatalistic views.
The higher risk of death, in other words, had nothing to with the usual heart disease culprits -- age, blood pressure, cholesterol, weight. Instead, it tracked closely with belief. Think sick, be sick.
That study is a classic in the annals of research on the "nocebo" phenomenon, the evil twin of the placebo effect. While the placebo effect refers to health benefits produced by a treatment that should have no effect, patients experiencing the nocebo effect experience the opposite. They presume the worst, health-wise, and that's just what they get.
"They're convinced that something is going to go wrong, and it's a self-fulfilling prophecy," said Arthur Barsky, a psychiatrist at Boston's Brigham and Women's Hospital who published an article earlier this year in the Journal of the American Medical Association beseeching his peers to pay closer attention to the nocebo effect. "From a clinical point of view, this is by no means peripheral or irrelevant."
Barsky's target is drug side effects, which cost the U.S. health system more than $76 billion a year, according to a 1995 University of Arizona study. If even a small percentage of those costs are caused by patient expectations of harm, addressing the nocebo effect could save a nifty sum.
But convincing doctors that their patients' problems may be more than biochemical is no simple trick. The nocebo effect is difficult to study, and medical training leads doctors to seek a bodily cause for physical ills.
"Nocebos often cause a physical effect, but it's not a physically produced effect," said Irving Kirsch, a psychologist at the University of Connecticut in Storrs who studies the ways that expectations influence what people experience. "What's the cause? In many cases it's an unanswered question."
Looking for Trouble
The word nocebo, Latin for "I will harm," doesn't represent a new idea -- just one that hasn't caught on widely among clinicians and scientists. More than four decades after researchers coined the term, only a few medical journal articles mention it. Outside the medical community, being "scared to death" or "worried sick" are expressions that have long been part of the popular lexicon, noted epidemiologist Robert Hahn from the Centers for Disease Control and Prevention in Atlanta.
Is such language just hyperbole? Not to those who accept, for example, the idea of voodoo death -- a hex so powerful that the victim of the curse dies of fright. While many in the scientific community may regard voodoo with skepticism, the idea that gut reactions may have biological consequences can't be simply dismissed.
"Surgeons are wary of people who are convinced that they will die," said Herbert Benson, a Harvard professor and the president Mind/Body Medical Institute in Boston. "There are examples of studies done on people undergoing surgery who almost want to die to re-contact a loved one. Close to 100 percent of people under those circumstances die."
But the nocebo effect can lead to more subtle outcomes as well.
Fifteen years ago, researchers at three medical centers undertook a study of aspirin and another blood thinner in heart patients and came up with an unexpected result that said little about the heart and much about the brain. At two locations, patients were warned of possible gastrointestinal problems, one of the most common side effects of repeated use of aspirin. At the other location, patients received no such caution.
When researchers reviewed the data, they found a striking result: Those warned about the gastrointestinal problems were almost three times as likely to have the side effect. Though the evidence of actual stomach damage such as ulcers was the same for all three groups, those with the most information about the prospect of minor problems were the most likely to experience the pain.
Despite the smattering of doctors' anecdotal reports and a few modest clinical studies, research on the phenomenon has not been robust, mostly for ethical reasons: Doctors ought not to induce illness in patients who are not sick.
Changing ethical standards have made it difficult to even repeat some of the classic nocebo experiments. In one century-old effort, conducted long before anyone thought up the word nocebo, doctors set an allergy sufferer wheezing by showing an artificial rose, proving that at least some aspect of the allergic response is stimulated by visual cues. In a study from the early 1980s, 34 college students were told an electric current would be passed through their heads, and the researchers warned that the experience could cause a headache. Though not a single volt of current was used, more than two-thirds of the students reported headaches.
Medical Distrust
But resistance to in-depth study of the nocebo effect rests on more than ethical reservations, said the CDC's Hahn. Belief, he said, does not have a strong place in the anatomy-centered world of modern medicine.
"The fact is that phenomena that essentially come down to what people believe are conceptually difficult in our medical system," Hahn said. "Health is thought to be a biological phenomenon. More psychosomatic elements are hard to deal with."
Science is wearing away at the wall between mind and body. With the aid of high-tech imaging devices, neurologists are getting better at taking pictures of the brain in action. In one blinded study last year, researchers found that patients with Parkinson's disease given a placebo released a brain chemical called dopamine, just as the brain exposed to an active drug would do.
That flood of brain chemicals, it appears, has everything to do with what the mind expects. In most cases, like the Parkinson's study, the outcome is positive -- the placebo effect in action. But for some patients -- depressed, wary of medication or worried about drug side effects -- getting a prescription filled is an angst-ridden experience. And such patients appear even more likely to exhibit those side effects.
Barsky has even sketched out a profile of the kind of patient likely to experience the nocebo effect -- worse side effects and poorer outcomes -- on a given drug. When Barsky sees a patient with a history of vague, difficult-to-diagnose complaints who is sure that whatever therapy is prescribed will do little to battle the problem, he says, those low expectations are inevitably met. The treatments usually fail.
"Whether you trust your doctor or not probably makes a huge difference in whether you report side effects, but there's almost no data on that," Barsky said. He hopes to include information about a person's psychology in an upcoming placebo-controlled clinical trial to see if patients with a particular outlook on life fare better or worse than other subjects.
Far more esoteric factors may also shape both the placebo and nocebo response. A Dutch study, for example, found that most people considered red and orange pills to be stimulating, with blue and green-colored pills more likely to have a depressant effect.
"One of the most important things about a pill is [its] color," said Daniel Moerman, an anthropologist at the University of Michigan-Dearborn who has studied the placebo and nocebo effects across different cultures. "That seems to be fairly widespread."
But the mind is a funny thing, and generic responses to color go just so far in explaining the placebo or nocebo response. Consider this: In Italy, Moerman says, blue placebos made excellent sleeping pills for women but had the opposite effect on men.
The apparent reason? "The Italian national football team's color is azzurri," he said. "Blue."
Brian Reid is a Washington area freelance writer.
© 2002 The Washington Post Company
Reprinted from:
washingtonpost.com/wp-dyn/articles/A2709-2002Apr29.html
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armchairlinguist
USA
1397 Posts |
Posted - 10/11/2007 : 20:52:45
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One thing that sticks out to me is that the amount of stomach damage was the same for the aspirin study, but the pain varied. In that sense, it could be important to warn people, so that they feel the pain and then get it checked out.
Very fascinating article, thanks for posting it. Makes me wonder if my general belief that I don't get side effects from medicines might be the reason I don't!
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Wherever you go, there you are. |
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ralphyde
USA
307 Posts |
Posted - 10/12/2007 : 10:13:22
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Thanks for posting this. It is very important to TMS, as this is the same bias that we see against accepting TMS. quote:
Medical Distrust
But resistance to in-depth study of the nocebo effect rests on more than ethical reservations, said the CDC's Hahn. Belief, he said, does not have a strong place in the anatomy-centered world of modern medicine.
"The fact is that phenomena that essentially come down to what people believe are conceptually difficult in our medical system," Hahn said. "Health is thought to be a biological phenomenon. More psychosomatic elements are hard to deal with."
Here's what Dr. Marc Sopher says about the nocebos that conventional doctors sometimes create: quote:
Unfortunately, physicians are taught to find a physical cause for physical symptoms and thus tell their patients about their "back problem."
"Being told that you have a "problem" or "condition" can aid the "nocebo response." This is the opposite of the placebo response. With a placebo, belief in a worthless remedy can provide relief, almost always temporary, due to the desire to be well and faith in the value of the remedy. With a nocebo, symptoms will persist or intensify as a result of being informed, incorrectly, that a significant defect or problem is to blame. This is a critical part of conditioning - coming to believe that certain actions, circumstances, or aspects of the environment are the cause of symptoms, when in fact the cause lies in the mind."
Ralph |
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lidge
USA
184 Posts |
Posted - 10/13/2007 : 21:02:03
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RE Nocebo effect-
I had an epidural in my cervical spine that seemed to help my neck
and one in my back that seemed to do nothing.
If I accept that all my pain is TMS, will that reverse the presumed "placebo" effect of the cervical shot - that is, will the neck pain return because I now believe that the relief obtained from that shot was simply placebo?
Is it atypical to get relief in one area but not another? Does that mean that one believes one is truly physical but not the other? |
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armchairlinguist
USA
1397 Posts |
Posted - 10/14/2007 : 10:52:05
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lidge, I hope you are not offended by this, but I think you may be thinking too hard about all this, getting tied up in knots by all the possible complexities. If you want to try to treat your pain as TMS, then it may be more helpful to focus on the basic principles. The board doesn't really encourage this because so many people are in later stages of healing where exploring the nuances is helpful or interesting.
Focus on this:
If TMS:
1. The pain is not caused by organic dysfunction, but by repressed emotion, so the pain is not significant of physical problems, thus not necessary to worry about.
2. Acknowledge the existence of repressed emotions in yourself, and that this is normal for a person in our society. Think psychological (about emotions) not physical (about pain).
3. Treat the pain as unimportant (ignore it, fight it, or whatever is appropriate for you) and eventually/gradually return to normal activity.
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Wherever you go, there you are. |
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lidge
USA
184 Posts |
Posted - 10/14/2007 : 15:57:57
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Armchairlinguist- I am not offended by your posts. On the contrary.
Perhaps I should not be posting questions until such time as I absolutely and completely rule out physical causes.
I searched for Vitamin D deficiency on this board because I discovered I am very much below the minimum blood level and found a thread on JimmyJimmy who apparently spent years assuming everything was TMS when he had osteomalacia. I'm not sure what conclusion he came to in the final analysis.
Perhaps because I have found odd things - childhood leg problem, vitamin d deficiency, unusual degree of disc degeneration for my age. low bone density (not quite osteoporosis) and have just been sent in circles by uncaring doctors I wonder whether connections are being missed.
On the other hand, my pain though diffuse, is centered squarely on the
areas Sarno describes in the neck and lower back.
Getting physical causes of specific pain ruled out is tougher than you may think for some of us. Jimmy's story, though rare on this board, is an example.
The findings above have had a strong nocebo effect on me. In the final analysis, I have to rule out what is TMS and what is not.
Because it is clear to me that no doctor, TMS doctor or not can do this for me, I have posed questions on this board. If the board
is essentially support for those who are in the later stages of recovery, then I am surprised at some of responses. They sound
more like children whose playground has been invaded than englightened
veterans of TMS therapy.
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vikki
95 Posts |
Posted - 10/14/2007 : 16:29:52
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I've always wondered about the studies they do that show structural back problems (herniated dics, etc) are equally common in people with and without back pain. I assume they do MRIs of the two groups (with and without pain), then find a roughly equal proportion of them have disc abnormalities. Do they then tell those without pain about the abnormalities they found? Do the pain-free people then go on to experience pain (nocebo effect)? I'd be really interested to know the results of this kind of follow-up, if anyone has done one.
Lidge -- I read your posts, and I just want to offer one bit of advice. You will *never* absolutely and completely rule out physical causes. I am like you -- I always want to be sure. But part of overcoming this for me was to start treating it as TMS *despite* doubts -- that was my leap of faith, and it worked. You can never be sure (of this or anything else), and I think you have to live with that uncertainty. Where do you live? It might be helpful to you to see a TMS doctor, if you can. They can talk to you about the relationship between the physical issues you mentioned, and the pain you feel. (The TMS doctor I saw was helpful in pointing out things like, "If your problem really was X, you would feel the pain in a completely different location.") |
Edited by - vikki on 10/14/2007 16:41:18 |
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armchairlinguist
USA
1397 Posts |
Posted - 10/14/2007 : 17:43:13
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Hi lidge,
I certainly don't mean that you shouldn't post questions or that this board isn't for people newly looking into TMS -- sorry if it sounded that way. Absolutely you should post and you are very welcome. It's just that the information overwhelm on the board can be significant and can distract from the essentials about TMS. I think that focusing on the essentials is important.
As I'm not a doctor, I can't really say what you should do. If you do have identifiable problems like vitamin D deficiency, definitely get those treated. It's mainly if you get all the tests and they don't really find anything except herniations, stenosis, etc. that are "normally abnormal" that TMS is the thing to look for.
Another thing you can do is do it in reverse, sort of. Assume that some of the pain is TMS, and treat it all as such, and see what goes away and what doesn't. This isn't a foolproof method (since TMS pain can take a while to go away) but it might help clear some things up.
If you're near a TMS physician, it's probably worthwhile to see him or her so you can discuss your doubts and they can allay some worries and make sure you get the tests you need to rule in or out what's worrying you.
In the end you may or may not have the opportunity to get a definitive diagnosis. I also had to take a leap of faith and try doing activity that would normally trigger pain, but with an attitude that it would not, and that I could talk my brain out of it if it tried to. This worked for me, and thus it gave me confidence in my belief that I had TMS.
Do you see yourself in the TMS profiles? Are you a perfectionist or goodist? If you read the material and focus on the essentials, you can see if the description resonates for you. If it does, then it is worth at least pursuing as a possibility, even if you simultaneously are still trying to rule out certain physical issues. At the beginning, at least, there's no absolute need to choose one or the other.
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Wherever you go, there you are. |
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lidge
USA
184 Posts |
Posted - 10/14/2007 : 18:21:13
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Armchair and Vicki- thanks for the good advice- truly.
Armchair- alot of TMS resonates with me although I don't think I am a "goodist' but am a "worrier". In the DVD that Schechter puts out with his workbook there is one man (bearded) who had lived with pain and flown all over the country trying to get relief. He said "the pain had worn a path in his head." Boy, that resonated. And I could add to that, my experience with doctors has worn an even bigger path
in my head. My attitude at the moment is that I cannot bear ONE MORE DOCTOR doing that. Including a TMS one.
I think the finding of the Legg-Calve-Perthes (presumably) as the cause of the femoral head deformities particularly wore a path in my head. Here I am in my late forties being told I had some disease
as a teen that led to this, having the first report read "probable
avasuclar necrosis" - well, you can imagine. Not only the scare of having AVN, but the weirdness of it all. Then of course, you research the disease and get even more freaked out as you read it
leads to early osteoarthritis etc. This on top of the disc degeneration/MRI journey so many here have gone through.
Yes Vicki, I do wonder what most people would find if they looked.
The best pain drs. here only give fuzzy answers as to what is
really generating your pain - does it make sense etc.
If they see a herniated disc, that is what they treat. If you don't feel relief it can't be that they are wrong - its you the patient who
is just a "diagnostic challange". Then they send you to yet another
doctor.
At the end of the day I just want to get better. And yes, it would be a wonderful feeling to take back the power from the doctors.
Whatever doubts I have, I have no doubt that doing that will do me nothing but good.
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lambertus
Canada
6 Posts |
Posted - 10/14/2007 : 19:44:33
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Hi Lidge:
I'm not sure one should assume ALL their pain is due to TMS. I had a steroid shot in my neck 8 years ago. That specific pain has never returned. That was the only successful treatment I have had during my 44 years of chronic pain. It was also the only time a specific diagnosis has been made. With everything else, my tests all come back normal. I can only assume that the spot that was fixed had a physiological base while the rest of my pain is psychological and is slowly responding to TMS treatment.
Hope this helps
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Edited by - lambertus on 10/14/2007 20:20:02 |
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skizzik
USA
783 Posts |
Posted - 10/16/2007 : 08:47:08
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lamb,
What if,
Since Sarno states that injections do work (temporarily) anyways, and they work for the most part a good 6 weeks when done for the 1st time......then perhaps you were on the verge of something stressful that came and went in those 6 weeks that the steroid was doing it's job?
Hence, the distraction was no longer needed...Can you take a moment to think hard about what was going on in your life then, and what may have transpired, or perhaps there was an unsolvable conflict bothering you that you finally came to terms w/ and have accepted that rendered the pain distraction useless? |
Edited by - skizzik on 10/16/2007 08:49:14 |
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lambertus
Canada
6 Posts |
Posted - 10/16/2007 : 19:20:31
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Good question skizzik. There were lots of things going on in my life at that time and lots of pain, not just the neck. The rest of the pain remains a battle but the severe neck pain started suddenly after a chiropractic adjustment (the first and last time I let a chiro near my neck) and as it has not returned in 8 years I think it may have been physiological. I will however make a note in my journal to think about the timing. You could be right.
Anyway, I think it is important not to assume that all pain is TMS. Maybe 99 percent is, but it is the 1% that can get you. I thought my husband was having a tension migraine; he almost died of a cerebral aneurysm. I don't think there is anything wrong with having a doctor assess the pain, especially a new or different pain; if the report comes back with what we know is TMS, no harm done. Of course, here in Canada we don't get tests and reports for 6 to 8 months but that's another story! |
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2scoops
USA
386 Posts |
Posted - 10/23/2007 : 08:51:26
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Well, I I like what the article says about, think sick, act sick.
I have been recently diagnosed with high blood pressure and chlosterol. I also work at a health clinic, so I constantly get harped on the blood pressure. When they do that, it only makes it worse because I dwell on it. It makes me feel sicker. Than, worry sets in, and than I start thinking about having a stroke or heart attack. So, it's not hard for me to believe that we self fulfill some of our health problems. Just like when a doc says a bulding disc causes back pain. We just don't move and bend the same way, therefore, we create more pain or make the duraton of pain longer.
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The Nocebo Effect
