The Power of Suggestion

We have all heard the term “Placebo”. A placebo is a treatment that decreases symptoms only because the client imagines a benefit, not because the treatment itself has any effect. For example, a sugar pill can be a placebo that will improve a headache only if the person taking the pill has an expectation that it will provide benefit. The placebo effect is the physiological process by which expectations about a treatment cause changes in the brain that initiate an improvement in symptoms.

Well, the contrast to this is a “nocebo”. A nocebo causes negative changes in symptoms (e.g. more pain and reduced function) when there is an expectation that an otherwise harmless stimulus will cause harm. Consider the person who thinks that bending and touching their toes will cause them pain, because the last time they did this, it did. The chances of them experiencing discomfort are pretty high. Over time, they avoid this movement and essentially create the harm that they anticipated because they have not moved properly due to this nocebo effect in thinking. Think self-fulfilling prophecy.

Many think of placebo as a mind-body connection that is a mysterious process without explanation. But in fact, we have connections between abstract thoughts and the body all the time. However, we never logically conclude this in real time. If I think there is danger in a dark alley I’m approaching, than my heart begins to beat faster. If I am nervous before a presentation, my hands begin to sweat. These are all reactions to our own thoughts. It’s not magic. There is a connection.

Well, what if the effect of your care is a “nocebo”? The opposite of a placebo. A nocebo is a detrimental effect on health produced by psychological or psychosomatic factors such as negative expectations of treatment or prognosis. This type of effect actually occurs much more often than the placebo effect. A nocebo effect is often innocently injected into our daily lives or even into our rehabilitation models. As an example, if you go for an MRI and the doctor tells you that they see a bulging disc, you may start to feel more pain, even if the pain you feel has nothing to do with the MRI findings. However, what if they continued to tell you that there is poor correlation between back pain and MRI findings? This can change the way you take in that information. If your therapist tells you that your hamstrings are tight, you may start to shorten your stride or be concerned about the first minor twinge you feel in the hamstring the next time you think you are about to pull something.

Ultimately, what we are learning more and more is that how we think about an injury and how we are spoken to by professionals who we look to for comfort, can have as big of an impact on recovery as the treatment approaches themselves. How many of us have walked into a doctor’s office and seen a model of a spine with the disc sitting next to it? This is what people think happens to “slipped discs”. It’s not. Not even close. But that imagery has a huge impact on how someone who has a slipped disc, can feel. As a matter of fact, many you reading this right now may have a slipped disc, but not even be aware of it. Again, follow the science. Correlation does not equal causation. We must all, professionals and patients, reshape the words we use to express what we are experiencing. This goes a long way in moving past problems related to pain and trauma in our lives.