How "Nocebos" Are Keeping You In Pain

*The following is an excerpt from my upcoming book about lower back pain. Here, I talk about the dangers of fear and misinformation when it comes to treating people in pain.

The placebo effect occurs when a patient's physical or mental health improves after receiving a sham (fake) treatment, such as a sugar pill. This happens because of the psychological effects of the belief and expectation in the treatment.

Placebos have an evil twin, nocebos. It’s the opposite of a placebo and about five times as strong, because we introduce fear into the mix.

Fear is one of the most powerful motivators, and some will argue that everything we do in life is motivated simply by pain and pleasure. Fear can cause us to be completely irrational and perceive threats that aren’t logically there.

“You’re going to blow your back out doing that.”

“You’re too old for that. Shouldn’t you be slowing down?”

“Running is terrible for your knees. You shouldn't be doing that anymore."

(noh-SEE-boh): A harmless substance or treatment that may cause harmful side effects or worsening of symptoms because the patient thinks or believes they may occur or expects them to occur.

Just as much as when we believe something will work, it has a greater chance to; if we believe something is dangerous, it’s more likely to cause problems.

For example, if I believe bending down to tie my shoes (and leaving a neutral spine posture) is inherently dangerous, I’m more likely to avoid it, be afraid of it, and feel stiff and potentially painful when doing it.

Hearing statements and advice like this naturally will make you fearful of movement and exercise, and therefore less likely to do the thing that’s going to help you.

Case in point, I was seeing a client in her 60s for significant knee pain, and she was seeing fantastic progress.

Then she went to her doctor. While she happily told her about her new strength training routine and how much better she was feeling, her doctor was horrified.

“That’s extremely dangerous. You need to be careful, especially at your age.”

How do you think she felt after hearing this?

With all the progress she was making, she felt incredible. Now, she had new fears and anxieties brought up by someone who is an authority figure and should know what they’re doing.

This is the nocebo effect.

Doctors and physios can be the worst offenders, but it can come from friends and family just as easily.

Unfortunately, even though we have mountains of evidence stating the benefits of progressive strength work for pain and injury, we as a culture still believe that weight training is inherently dangerous.

I bring this up to demonstrate how dangerous these myths about pain can be. It can stop someone from taking the actions that are going to help them break the cycle of pain.

To your good health,

Coach Stephen

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 Thanks for reading.

P.S.

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