Flutterby™! : Nocebo, pain, and itchy creams

Believing a drug costs more can amplify the patients placebo/nocebo experience of negative side-effects: Interactions between brain and spinal cord mediate value effects in nocebo hyperalgesia

Value information about a drug, such as the price tag, can strongly affect its therapeutic effect. We discovered that value information influences adverse treatment outcomes in humans even in the absence of an active substance. Labeling an inert treatment as expensive medication led to stronger nocebo hyperalgesia than labeling it as cheap medication. This effect was mediated by neural interactions between cortex, brainstem, and spinal cord. In particular, activity in the prefrontal cortex mediated the effect of value on nocebo hyperalgesia. Value furthermore modulated coupling between prefrontal areas, brainstem, and spinal cord, which might represent a flexible mechanism through which higher-cognitive representations, such as value, can modulate early pain processing.

Science 06 Oct 2017: Vol. 358, Issue 6359, pp. 44 DOI: 10.1126/science.aap8488

Letter to Science by the author.

Via the Ars Technica write-up: Potent Nocebo: The more expensive a harmless cream, the more pain it inflicts.

Specifically, researchers gave patients a sham anti-itch cream for eczema (atopic dermatitis) and told them it increases sensitivity to pain as a side effect—which is a side effect of real medicines, but the phony cream shouldn’t have any side effects. Nevertheless, patients not only reported more pain, but the amount of pain they reported depended on the cream’s price and packaging. The cream caused more pain in patients when they were told it had a hefty price tag and came in a brand-name-looking box, compared with when they thought it was a cheap cream that came in a generic-looking box. ...