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Can A Fear of Side Effects Affect Your Outcome?

We’re exploring the fear of side effects and how it may affect treatment.

Have you ever read the leaflet section that comes with medication? Typically, it’s a long list of possible side effects that upon reading, may be enough to give anyone hives (ironic if you’re taking medication for hives in the first place).

The thing is, some of the side effects listed on these leaflets are rare. So why do pharmaceutical companies bother including them? Because safety and efficacy is something that is strictly regulated when dealing with medication, and pharmaceutical companies take it seriously. That’s why medications undergo years of study before health authorities approve said medications and ensure that the benefits outweigh the risks they may be associated with them.1 And, as you may have noticed, this can create a long list of potential side effects listed on those leaflets.

Unique like a snowflake

Remember when your grade school teacher told you that ‘you are unique like a little snowflake’? Well, they were right, and it still applies when taking medication. People react differently to treatments – and furthermore what bothers some may not bother others. For example: Two people could both experience the same side effect when taking headache medication – in this instance let’s say dry mouth – and that particular side effect may be totally worth it for one of them, but be a deal-breaker for the other. This is why it’s so important to list all of the side effects, so that people can make the most informed possible decisions about their treatment options.

 

(For those that don’t know, most snowflakes are unique from one another. However, recent studies show they do follow a similar path.1 But don’t worry, you are still unique)

It is important to understand what your medication could be doing to your body. So, what’s the right first step in this process? Talk to your doctor. They are the ones that will help you decide if the risks are worth it. While it’s important to discuss the risks of possible side effects with your doctor, it’s also important to keep these possible side effects in perspective. Why, you may ask?

The Nocebo effect

Studies show that a fear of side effects can actually increase the likelihood of experiencing them2,3 and may even have a negative effect on treatment outcome. You’ve probably heard of the Placebo effect, also called the Placebo response. The Placebo affect is a remarkable phenomenon in which a placebo - a fake treatment, an inactive substance like sugar, distilled water, or saline solution - can sometimes improve a patient's condition simply because the person has the expectation that it will be helpful. The more a person believes they are going to benefit from a treatment, the more likely it is that they will experience a benefit. Well, the reverse can also happen, a phenomenon known as the Nocebo effect where an approved treatment taken by or administered to a patient is associated with harmful side effects or worsening of symptoms due to negative expectations or the psychological condition of the patient.4,5  Take this study, for example: Out of 2,026 placebo-related patients, 67% of people taking a placebo experienced at least one side effect. 10% of these individuals felt that the side effect was bad enough to make them stop treatment.6

Experts are increasingly interested in the nocebo effect because it can affect drug adherence, which is the extent to which patients take medications as prescribed by their healthcare provider.7 After all, if you’re dreading a particular side effect you may stop treatment at the slightest sign of a problem. So, where do these negative expectations come from? Well, sometimes it might be from a bad experience with a different drug in the past,8 or perhaps it’s the experiences of others you might have heard about or read online.9  Keep in mind, if you do actually experience side effects, let your physician know about it.

Whatever the case, it’s important to try not to let negative preconceptions affect you or your treatment program. Remember, it is also possible that stress may play a role in skin conditions like psoriasis10 and CSU,11 so the last thing you want is for your treatment to add stress to your life! Be honest with your doctor about your concerns and what matters most to you. Together you can discuss the risks and benefits of treatment and make the right decision for you.  

  1. National Psoriasis Foundation. Does fear affect your treatment choice?

    https://www.psoriasis.org/about-psoriasis/treatments/addressing-fear-of-side-effects
  2. Snowflakes All Fall In One of 35 Different Shapes http://www.smithsonianmag.com/smart-news/snowflakes-all-fall-one-35-different-shapes-180953760/

  3. The Effect of Treatment Expectation on Drug Efficacy: Imaging the Analgesic Benefit of the Opioid Remifentanil. Bingel U, Wanigasekera V, Wiech K, Ni Mhuircheartaigh R, Lee MC, Ploner M, Tracey I. Sci Transl Med. 2011 Feb 16;3(70):70ra14. https://www.ncbi.nlm.nih.gov/pubmed/21325618
  4. Nocebo in fibromyalgia: meta-analysis of placebo-controlled clinical trials and implications for practice. Mitsikostas DD, Chalarakis NG, Mantonakis LI, Delicha EM, Sfikakis PPEur J Neurol. 2012 May;19(5):672-80. https://www.ncbi.nlm.nih.gov/pubmed/21973313
  5. The nocebo effect of drugs. Planès S, Villier C, Mallaret M. Pharmacol Res Perspect. 2016 Mar 17;4(2):e00208. https://www.ncbi.nlm.nih.gov/pubmed/27069627
  6. The nocebo effect of drugs. Planès S, Villier C, Mallaret M. Pharmacol Res Perspect. 2016 Mar 17;4(2):e00208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804316/
  7. Nocebo in fibromyalgia: meta-analysis of placebo-controlled clinical trials and implications for practice. Mitsikostas DD, Chalarakis NG, Mantonakis LI, Delicha EM, Sfikakis PPEur J Neurol. 2012 May;19(5):672-80. https://www.ncbi.nlm.nih.gov/pubmed/21973313
  8. The New England Journal of Medicine. Drug Adherence. 2005. 353:487-97 http://www.nejm.org/doi/full/10.1056/NEJMra050100
  9. The nocebo effect: patient expectations and medication side effects Kate Faasse, Keith J Petrie. PGMJ Online First, published on July 10, 2013 as 10.1136/postgradmedj-2012-131730. https://www.fmhs.auckland.ac.nz/assets/fmhs/som/psychmed/petrie/docs/2013-nocebo-review.pdf 
  10. The nocebo effect: patient expectations and medication side effects Kate Faasse, Keith J Petrie. PGMJ Online First, published on July 10, 2013 as 10.1136/postgradmedj-2012-131730. https://www.fmhs.auckland.ac.nz/assets/fmhs/som/psychmed/petrie/docs/2013-nocebo-review.pdf
  11. Stress and Psoriasis. Psychoneuroimmunologic Mechanisms. Eugener M. Farber, Glen Rein. and Sean W. Lanigan. International Journal of Dermatology. Volume 30, Issue 1, pages 8–12, January 1991. https://www.ncbi.nlm.nih.gov/pubmed/2261789
  12. Stress, insomnia, and chronic idiopathic urticaria ­– a case-control study.

    Yang HY1, Sun CC, Wu YC, Wang JD. Formos Med Assoc. 2005 Apr;104(4):254-63. https://www.ncbi.nlm.nih.gov/pubmed/15909063 

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