What is the Nocebo Effect?

I wrote a little on my social media yesterday about avoiding nocebo-ing myself last year when I was going through an injury – but what IS the Nocebo effect?

I think it’s particularly important for practitioners and coaches to be aware of, but it’s also good to think about how we speak to ourselves when we’re in a rehab process.

The Nocebo Effect

The nocebo effect is essentially the opposite of placebo; when we believe or expect that something will harm us (or not help), that is indeed more likely to be the case.

From Rossetini et al., 2022:

“Negative expectations impact [musculoskeletal] pain, playing a significant role in transitioning from acute to persistent pain, and maintaining symptoms. Moreover, they can bias symptom perception and reduce treatment effectiveness, inducing nocebo-related effects.

Within the MSK context, nocebo-related effects refer to those negative responses that follow treatment administration (i.e., painkillers, manual therapy, and therapeutic exercises) associated with a negative expectation.

Investigating patients’ beliefs and expectations represent a priority for clinicians treating MSK pain.

However, such practice is not routinely implemented in clinical practice.

As emerged in previous surveys, clinicians involved in MSK care report difficulties in managing patients’ expectations and avoid nocebo-related effects.

This lack highlights the need for clinicians to have a framework that they can apply in everyday practice.”

Suggested Reading for Practitioners

There’s been a ton of attention to how patient expectations and beliefs can affect outcomes in recent years. Here are a few papers I highly suggest reading if you work with people with injuries:

🌀 Unraveling Negative Expectations and Nocebo-Related Effects in Musculoskeletal Pain – Rossenttini et al, 2022
🌀 Are patients picking up what we are putting down? Considering nocebo effects in exercise for musculoskeletal pain – Cormack & Rossettini, 2023
🌀 Sticks and Stones: The Impact of Language in Musculoskeletal Rehabilitation- Stewart & Lotus, 2018

Plus see below for some of the positivity and reframing conversations that got me through – a massive shout out as always to my dear friend, former colleague and amazing human Arthur Woznowski-Vu.

As Jacob Templar always says – “Are you gonna let the nocebros win?”