Some Fibromyalgia Patients Experience Reverse-Placebo Effects

Patient Expert

We've all heard of the placebo effect - when a patient so strongly believes a new treatment will work that they experience improvement even though the treatment may not be real.   Did you know that there is also a nocebo effect?   It's the opposite of a placebo effect.   If a patient has strong negative expectations that a treatment will harm rather than heal, they are likely to experience more adverse side effects.

A new study reported in the European Journal of Neurology found that fibromyalgia patients are particularly susceptible to the nocebo effect.

Study Design and Results

Researchers looked at randomized clinical trials for FM pharmacologic treatment between 2001 and 2010.   They assessed the number of placebo-treated FM patients reporting at least one adverse effect, then compared them with similar multiple sclerosis and primary headache patients.

The scientists found that 67% of the FM patients receiving a placebo reported at least one adverse effect and nearly 10% dropped out of the clinical trial because of intolerance.   Interestingly, the figures were essentially the same for the patients receiving the actual drug.   It was also noted that FM patients who also had depression were more likely to withdraw from the clinical trials.

Nocebo dropouts in the FM trials were four times higher than in trials for multiple sclerosis treatment and two times higher than in trials for migraine preventive treatment.   The researchers concluded that the nocebo effect is remarkable prevalent in FM patients participating in randomized clinical trials.

My Thoughts...

I've long thought that our minds, specifically our tendency toward a positive or negative attitude, has a huge impact on how effective various treatments are for us.   But seeing that two-thirds of the FM patients studied experienced a nocebo effect was a real eye-opener.

I probably shouldn't be surprised.   Since so many FM patients go through years of trial and error to find a treatment combination that works for them, it's not surprising that they would become highly skeptical and doubtful about the potential effectiveness of yet another new treatment.

Add to that the fact that FM patients often have a lot of allergies and are sensitive to many medications.   If you have had adverse side effects from several different medications, it would be hard not to anticipate having them when you try a new medication.

Whether or not there is a legitimate reason for having a negative attitude, though, doesn't take away from the fact that such an attitude can interfere with finding an effective treatment.   The next time you get ready to try a new treatment option, think about your expectations.   If you find that you're not expecting it to work, talk it over with your doctor and try to focus on all the reasons it should work for you.   It's to your benefit to give the new treatment the best possible chance to work for you.

For more information on how to approach and evaluate new treatments, read "Patients Need Patience: How to Evaluate Treatment Options"

Mitsikostas DD, et al. Nocebo in fibromyalgia: meta-analysis of placebo-controlled clinical trials and implications for practice. Eur J Neurol. 2011 Oct 4.