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October 11, 2017

When is a placebo 'worse' for patients? When they think it's expensive, study finds

Daily Briefing

    Patients are more likely to report experiencing side effects when they believe a medication is expensive—even if the drug is a placebo, according to a new study in Science.

    Help your patients on high-cost drug regimens plan for out-of-pocket expenses

    Study details

    For the study, researchers at the University Medical Center Hamburg-Eppendorf in Germany gave 49 volunteers two anti-itch creams—one packaged in an "expensive" looking package and another in "cheap" packaging—and told participants that a possible side effect was a sensitivity to heat, though they said side effects could differ between the creams. In reality, participants received the same cream, which did not contain any active ingredients.

    After applying the cream, the volunteers were given heat tests, during which participants using the expensive-looking cream said they felt nearly 30 percent more pain than those using the cheaper-looking cream.

    The researchers also took functional magnetic resonance imaging (fMRI) scans of the volunteers' brains to simultaneously examine which regions of the brain and spinal cord were processing participants' perceived sensation of pain. Alexandra Tinnermann—a doctoral candidate at the University Medical Center and lead author on the study— said prior research has generally focused on one location or the other. The researchers found that the level of activation in nerves along the pathway connecting the brain and spinal cord was associated with the overall amount of pain people said they experienced.


    The researchers were studying the so-called "nocebo" effect, or the study of a placebo's negative side effects rather than its positive ones, Newsweek reports,

    Citing the findings, Tinnermann said the "expectations ... patients have matter," adding, "This is something doctors should be aware of and make use of to create positive expectations and reduce negative ones."

    For instance, according to an editorial published alongside the study, the way providers speak to patients participating in a clinical trial about an experimental drug's side effects could make a nocebo effect more or less likely.

    Separately, A. Vania Apkarian, a pain researcher at Northwestern University who was not involved in the study, said this research will advance how we look at the way biases influence health care. He explained that while "we have assumed for many years that the brain would control pain perception at many different levels and that expectations would change those things," this study was the first to show the full circuity connecting expectations and perceptions (Thielking, "Morning Rounds," STAT News, 10/6; Bakalar, "Well," New York Times, 10/5; Sheridan, Newsweek, 10/5).

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