{"id":3190,"date":"2022-09-21T13:39:58","date_gmt":"2022-09-21T03:39:58","guid":{"rendered":"https:\/\/mindbodyfoodinstitute.com\/?p=3190"},"modified":"2025-12-16T11:59:58","modified_gmt":"2025-12-16T01:59:58","slug":"the-link-between-the-nocebo-effect-and-chronic-pain","status":"publish","type":"post","link":"https:\/\/mindbodyfoodinstitute.com\/the-link-between-the-nocebo-effect-and-chronic-pain\/","title":{"rendered":"The Link Between The Nocebo Effect And Chronic Pain"},"content":{"rendered":"\t\t
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We\u2019ve all been there some time or other: we get injured or start experiencing some form of pain, and the people around us will all come up with their own suggestions, sometimes even with a full retelling of their own painful experience;<\/p>

\u201cDon\u2019t carry too much weight!\u201d, \u201cBe careful at the gym!\u201d, \u201cit took very long to get better after I got that\u201d,\u00a0<\/i>or, the worst of the worst: \u201cYour pain might be chronic<\/i>\u201d.\u00a0<\/p>

Well-intentioned as it may be, what most of us fail to recognize when we get this sort of advice is the impact that it can have on our minds, and eventually on our own physical reality. Having introduced the possibility that pain is likely and imminent, it is very possible that people who have been subject to such a warning, and who are already in a state of stress or fear of re-injury, will experience the pain again.\u00a0<\/p>

I remember very clearly the day when a nerve specialist warned me not to climb or do any kind of sports anymore because I had severe nerve pain, even though the tests didn\u2019t reveal anything serious. \u201cDon\u2019t climb\u00a0ever again<\/i>\u201d was his final warning as I walked out of his clinic, attempting to run away from these dreaded words. Rock climbing was my passion, part of my identity, and I didn\u2019t want to believe him.<\/p>

But still, at the time I still considered a medical professional\u2019s advice as \u2018the absolute truth\u2019, and the next time I simply held on to a rock for a couple of seconds, the shooting pain that I experienced was almost unbearable \u2013 it was like my nerves had become electrified!<\/p>

What happened to me at the time, which is so common among chronic pain sufferers, is the opposite of what we know as the Placebo Effect;<\/strong><\/p>

While a Placebo works by implanting the suggestion in a person\u2019s mind that a drug or treatment might work effectively, the Nocebo comes into effect when the possibility for further pain or illness is foreseen. The mind absorbs the suggestion that healing might not take place, and the more suggestible a person is, the stronger its hold will be.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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How health professionals contribute to the Nocebo effect<\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Not surprisingly, the Nocebo effect works particularly well when we get the \u2018bad news\u2019 from a doctor or health professional, as was the case with me. This is because if we respect a person\u2019s opinion and hold him as an authority on the subject, we accept it as our truth much more readily, and therefore it becomes much more likely for the expected result to take place:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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When the doctor erroneously tells the patient he has a bad back, or shoulder, or knee, suffering naturally increases due to the nocebo effect. The doctor has now delayed her healing indefinitely with faulty medical advice\u2060 - and harmed her - Steve Ozanich<\/i><\/div>\n\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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\u00a0<\/p>

In his book,\u00a0You Are the Placebo<\/i>, Dr Joe Dispenza illustrates a number of studies on the subject. Among them, he mentions a 1962 study conducted on Japanese children who were allergic to poison ivy. The children\u2019s forearm was rubbed with a real poison ivy leaf, but they were told by the medical personnel that the leaf was harmless. Then, their other forearm was rubbed with a harmless leaf, but this time they were told that this was in fact poison ivy.<\/p>

Surprisingly,<\/b>\u00a0all 13 children developed a rash on the arm rubbed with the harmless leaf, whereas 11 out of 13 children didn\u2019t develop a rash on the arm rubbed with the actual poison ivy!<\/b><\/p>

I find that Dispenza\u2019s question, which he poses on after he relates this and other similar studies, introduces a wonderful degree of hope, especially for chronic pain patients:<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Are we more likely to suffer from arthritis, stiff joints, poor memory, flagging energy, and decreased sex drive as we age, simply because that\u2019s the version of the truth that ads, commercial, television shows, and media reports bombard us with? What other self-fulfilling prophecies are we creating in our minds, without being aware of what we\u2019re doing? And what \u2018inevitable truths\u2019 can we successfully reverse simply through thinking new thoughts and choosing new beliefs? - Dr Joe Dispenza<\/i><\/div>\n\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\u00a0The Nocebo, the Placebo and Chronic Pain<\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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So how does the Nocebo Effect relate to chronic pain?<\/strong>\u00a0Unfortunately, the link between the two is a cruel reality that a lot of pain sufferers are unaware of. Especially if the pain is dubbed as \u2018chronic\u2019 by a medical professional, the Nocebo Effect can continue its relentless rule. One very sad example is the case of fibromyalgia sufferers; having been told that \u2018there is no cure\u2019 for the condition, sufferers adopt this as their truth, and continue to \u2018expect\u2019 pain throughout their lifetime.<\/p>

This is not to say that the pain is in their heads, however. What the Nocebo Effect does in the case of chronic pain is help with the formation of neural pathways in the brain that lead to a reaction in the body which causes very real pain. For this reason, the pain is \u2018not all in your head\u2019, but is actually a physical manifestation that follows a subconscious thought or belief. You can compare it to salivating at the thought of food even when there is no food \u2013 a physical, automatic reaction to an emotional stimulus, expectation or ingrained belief.<\/p>

On the contrary, the Placebo effect may lead to complete healing even if no drug or surgery is involved<\/strong>.<\/p>

This was proven thanks to a variety of sham surgeries conducted on chronic pain patients, including the 2002 study by the Baylor College of Medicine, which involved 60 people with osteoarthritis in their knees. These patients were divided into three groups; two of these groups had two different kinds of arthroscopic knee surgery, while the other was given a sham surgery, involving incisions on their knees with no actual surgery.<\/p>

A year later, \u201call three groups reported equal amounts of improvement in pain and function<\/i>\u2060\u2014<\/i>and the same held true two years after surgery<\/i>.\u201d<\/p>

Does this mean that these people didn\u2019t have osteoarthritis to begin with?\u00a0<\/strong>The answer is probably no. They did have osteoarthritic knees, but this didn\u2019t have to hurt.<\/p>

It is similar with regard to a lot of structural conditions we are diagnosed with: muscle imbalance, herniated disks, scoliosis: our bodies are not structurally perfect, but these structural abnormalities may still not be the cause for our pain.<\/p>

The real danger strikes when professionals tell us that they really are the true sources of pain, planting the seeds in our minds that our bodies are \u2018weak\u2019 and prone to further pain or injury<\/b>.<\/p>

This is what makes our pain chronic more often than not, especially if we\u2019re already in a state of emotional imbalance or stress, which makes our brain even more suggestible to the Nocebo Effect. As Steve Ozanich puts it:<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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Healers determine the health realities for societies, based on their experience and training with causes and effects. When a physician tells the patient he has bad knees or feet, or back or neck, he believes the healer at a deeper level of consciousness - filling the patient\u2019s dry river bed, helping to form his persona unconscious. People normally believe what the physician tells them, especially if it allows them to opt out of things they don\u2019t want to do - avoid places they don\u2019t want to be. Even if the physician is wrong, most people will believe him or her because of their position of influence. If your doctor doesn\u2019t believe Dr Sarno, and you believe in your doctor, then that\u2019s it - your healing has been negated - Steve Ozanich<\/i><\/div>\n\t\t\t\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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\u00a0<\/p>

Overcoming the Nocebo Effect through the TMS approach<\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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My own chronic pain persisted until I discovered that what I was actually suffering from was TMS (Tension Myositis Syndrome). This is a condition discovered by an American Professor of Rehabilitation Medicine called Dr Sarno, after years of unsatisfying results with chronic back pain patients.\u00a0<\/p>

Doctors had already sent me to get diagnosed for fibromyalgia because my pain clearly corresponded to fibro symptoms. I was very lucky to discover Dr Sarno and the TMS approach\u00a0before I got my diagnosis confirmed, before I decided to join one of the several support groups where members compare symptoms, rate meds and vent about their pain without ever envisaging the possibility for complete healing, thus sending themselves on a continuous downward spiral of permanent pain. According to Dr Sarno, fibromyalgia is but one extreme form of TMS, and if looked at from that angle, the pain will make incredible sense.<\/p>

If you read up on Dr Sarno and TMS, you\u2019ll learn a new way of understanding chronic pain, as a kind of pain that manifests as a result of deeply repressed emotions or high levels of stress and which becomes chronic because we start fearing or believing that it will never go away. Once you start seeing your pain for what it really is, and learn the true distinction between acute and chronic pain, you\u2019re on your way to complete healing.<\/p>

But for true healing to occur, you need to stop fearing the pain and any warnings that trigger the Nocebo effect, because when we fear a certain kind of pain we are strengthening the neural connections associated with that pain, and so the cycle of chronicity continues<\/strong>.\u00a0<\/p>

The Nocebo Effect is only part of the puzzle when it comes to healing from chronic pain. The TMS approach addresses other aspects, especially related to a person\u2019s personality and other thought patterns that contribute to pain. Part of my job as a Pain Coach is to insist that the condition is much more common than people think it is, and that it can effectively treat a variety of pain symptoms, in fact, almost all chronic pain symptoms that are not a result of infection, acute injury or disease.<\/p>

If the pain has persisted for over 6 months, if there are changes in intensity during the day or week, and if it tends to change location and recur on both sides of the body, then there is a very strong likelihood that it is none other than TMS.\u00a0<\/p>

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So do you still think that you\u2019ve got a bad back\/shoulder\/foot?<\/i><\/h4>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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The information I learned as part of my TMS healing journey helped me distinguish what actually made sense and what didn\u2019t in relation to my symptoms. I learnt that it\u2019s highly unlikely for someone to be in such extreme pain following a \u2018harmless\u2019 activity that our body was designed for, like sitting down, carrying a light shopping bag or walking for 5 minutes.\u00a0In fact, our bodies are meant to carry out much more strenuous activities and to recover pretty fast even following an injury.<\/p>

More often than not, it is fear of re-injury and excessive attention to pain (which is none other than the Nocebo effect at play) that makes pain chronic, so that it persists for far longer than it should<\/strong>.<\/p>

I\u2019ve been pain free for almost 4 years now, exerting myself as much as I like on the rocks, firm in my belief that my workouts are in no way harmful to my body. The only \u2018treatment\u2019 that fully worked for me, and for many other chronic pain sufferers, was the TMS approach, the one advocated by Dr John Sarno, which amongst other things, teaches you about the danger of the Nocebo effect.\u00a0And if you\u2019ve been seeking relief from your own symptoms, why not stop for a minute and take some time to pursue complete healing first?<\/p>

TMS is not a pain relief treatment \u2013 it is an exercise in self-awareness, and a very useful lesson on the body and mind\u2019s amazing capabilities that may save you from a lifetime of needless pain.<\/p>

I would give it a try,\u00a0just in case<\/i>.<\/p>

\u00a0<\/p>

References\/Resources:<\/div>
  1. Steve Ozanich,\u00a0The Great Pain Deception: Faulty Medi<\/i>cal Advice is Making us Worse<\/i>, 2018 ed. p. 136<\/li>
  2. Ikemi and S. Nakagawa, \u201cA Psychosomatic Study of Contagious Dermatitis\u201d, Kyoshu Journal of Medical Science, vol. 13, pp. 335-350, 1962.<\/li>
  3. Dispenza,\u00a0You are the Placebo: Making Your Mind Matter<\/i>, Hay House, 2014, pp. 31-32.<\/li>
  4. B. Mosely et al, \u201cA Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee,\u201d\u00a0New England Journal of Medicine\u00a0<\/i>2002; 347: 81-8<\/li>
  5. Webmd,\u00a0https:\/\/www.webmd.com\/osteoarthritis\/news\/20020710\/popular-knee-surgery-may-be-useless#1<\/a><\/li>
  6. Steve Ozanich,\u00a0The Great Pain Deception: Faulty Medical Advice is Making us Worse<\/i>, 2018 ed. p. 146<\/li><\/ol>

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    Featured image by Towfiqu barbhuiya<\/a> on Unsplash<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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    Author:\n
    Miriam Gauci Bongiovanni<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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    Miriam is a MindBody Practitioner and Coach specialized in the field of Chronic Pain Healing. She is also the author of the MindBody Syndrome Practitioner Certification Course<\/a> at the Institute. After having suffered from a range of chronic symptoms, in 2016 she came across the MindBody Syndrome\/TMS approach to healing, and made a swift recovery by tapping into the mindbody connection, mindfulness meditation and neuroplasticity. Her inspiring recovery led her to pursue her MindBody Practitioner certification<\/a> and to seek more knowledge in the field of Neuroscience and Pain Science. Since 2019, she has been coaching people on how to overcome chronic pain through emotional work and brain rewiring techniques.<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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    We\u2019ve all been there some time or other: we get injured or start experiencing some form of pain, and the people around us will all come up with their own suggestions, sometimes even with a full retelling of their own painful experience;<\/p>\n

    \u201cDon\u2019t carry too much weight!\u201d, \u201cBe careful at the gym!\u201d, \u201cit took very long to get better after I got that\u201d, or, the worst of the worst: \u201cYour pain might be chronic\u201d. 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