Your mind can influence the effectiveness of the medicines you take

The effectiveness of a drug is not only reliant on its chemical components, but also to a certain extent, the patient’s expectations of its efficacy. — dpa

Not only is the medicine that patients take important for healing, but also whether or not they think the prescribed pills, ointments, syrups or procedures will work.

This is evidenced by two phenomena: the placebo effect and the nocebo effect.

Just about everyone is familiar with placebos, or dummy treatments.

“‘The placebo effect’ is the term for positive physiological or psychological changes after taking medications without any active ingredients,” says Dr Ulrike Bingel, professor of clinical neurosciences at Essen University Hospital in Germany.

It involves the expectancy effects caused by complex psycho-neurobiological processes in the brain, she explains.

Believing in a treatment’s effectiveness can activate mechanisms in the body that increase its effectiveness.

When they expect a positive outcome, patients draw on “a kind of endogenous pharmacy” whose activity is observable, according to Prof Bingel.

She says: ”Imaging procedures are able to show that certain brain regions are activated, for example, pain-relieving systems.”

So, if patients expect that taking a medication will reduce their pain, their brain releases pain-relieving substances.

It helps if they’ve experienced a remedy’s effectiveness multiple times in the past.

”If you know that pain relievers help alleviate headaches and take a placebo that you think is a headache tablet, it’ll probably have a positive effect,” says Dr Winfried Rief, professor of clinical psychology and psychotherapy at the University of Marburg in Germany.

The placebo effect isn’t just limited to drugs wholly lacking active ingredients.

“Almost all successful treatments in modern medicine involve the interplay of direct biochemical effects and psychological effects,” he says.

“For example, pain treatment studies suggest that a double dose of almost every medicine would have to be prescribed, were it not for the placebo effect.”

The opposite is also possible though, namely, the so-called nocebo effect.

It has two variants, according to Prof Rief.

First, a person can experience “biochemically inexplicable” side effects from a medicine, he says.

And second, an effective medicine may fail to have a positive effect.

In both cases, expectations are key.

“If, for instance, a patient hears from a neighbour or reads on the Internet that serious side effects can occur, then there’s a greater likelihood they will,” he notes.

Studies have shown that negative expectations can trigger physiological changes in the central nervous system.

“Fear of pain can block (pain-relieving) opioids and inhibit the (feel-good) neurotransmitter dopamine, for example,” Prof Bingel says.

“This intensifies pain conduction and perception, instead of down-regulating it.”

Doctor-patient communication is crucial when it comes to the placebo and nocebo effects.

“The treating physician can encourage positive expectations and confidence,” Prof Rief says.

“This plays a major role in a treatment’s effectiveness.”

Prof Bingel agrees, saying: “A doctor can tell you that 10% of patients experience side effects or that 90% tolerate the medicine very well.”

The facts are the same, but they’re presented differently.

”It’s not a matter of withholding or whitewashing information,” she says.

“But a doctor can convey it in a way that’s less frightening to the patient.” – dpa