Abstract Details

Title Out of Sight and Out of Mind: The Nocebo Effect; An Unmet ��ɫ��al Need in Academic Medical Centers

Topic Pain

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 12-003

Objective Our objective was to analyze the self-reported knowledge of the Nocebo effect, its evaluation, and its potential impact on clinical practice among physicians and medical trainees.

Background The Placebo effect is well known. The converse of this is the Nocebo effect, defined as adverse events that cannot be attributed to the properties of an intervention. The Nocebo effect appears highly prevalent in research of neurological and pain-related conditions. Placebo arm subjects reported adverse events 43-45% of the time in migraine prevention trials, 65-67% in Parkinson Disease and Fibromyalgia trials, and 80% in trials regarding motor neuron disease. Drop-out rates can reach as high as 10% due to Nocebo effects in these trials.

Design/Methods Participants included Neurology residents and Pain Medicine fellows from two academic medical centers. Participants completed a 10-item online survey regarding their knowledge of the Nocebo effect. All items were Likert scaled, with 5 total responses (Strongly Agree to Strongly Disagree).

Results N=24 participants completed the survey. Of these; 58.3% reported being familiar with the Nocebo effect; 75.0% felt the Nocebo effect impacted patient adherence and outcomes, and 91.7%felt further education on Nocebo effects would benefit their practice. Additionally, 91.7% reported no training about how to minimize the Nocebo effect; 91.7% were not familiar with Nocebo risk screening tools, and 83.34% felt unable to assess patients’ risk for Nocebo effects.

Conclusions The Nocebo effect is an important consideration in the management of many pain-related and neurological conditions. It may limit treatment effectiveness, limit the availability of treatment modalities, and cause significant distress to patients. While a majority of the surveyed trainees were aware of the Nocebo effect, very few had any knowledge of factors associated with this effect, how to screen for them or how to address these factors. This represents a significant gap in education that may be worsening treatment outcomes.

Authors/Disclosures
Derek J. Notch, MD (CHPG Neuroscience) PRESENTER	Dr. Notch has nothing to disclose.
Daniel Krashin, MD (Seattle VA)	Dr. Krashin has nothing to disclose.
Natalia Murinova, MD, FAAN (University Of Washington)	Dr. Murinova has nothing to disclose.

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