5 articles, page 1 of 5

Review article

Nocebo Phenomena in Medicine

Their Relevance in Everyday Clinical Practice

Dtsch Arztebl Int 2012; 109(26): 459-65; DOI: 10.3238/arztebl.2012.0459

Häuser, W; Hansen, E; Enck, P

Department of Internal Medicine I, Klinikum Saarbrücken and Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München: PD Dr. med. Häuser
Department of Anesthesia, University Medical Center Regensburg: Prof. Dr. med. Dr. rer. nat. Hansen
Department of Psychosomatic Medicine and Psychotherapy, University Clinic Tuebingen (UKT):
Prof. Dr. rer. nat. Dipl.-Psych. Enck

Background: Nocebo phenomena are common in clinical practice and have recently become a popular topic of research and discussion among basic scientists, clinicians, and ethicists.

Methods: We selectively searched the PubMed database for articles published up to December 2011 that contained the key words “nocebo” or “nocebo effect.”

Results: By definition, a nocebo effect is the induction of a symptom perceived as negative by sham treatment and/or by the suggestion of negative expectations. A nocebo response is a negative symptom induced by the patient’s own negative expectations and/or by negative suggestions from clinical staff in the absence of any treatment. The underlying mechanisms include learning by Pavlovian conditioning and reaction to expectations induced by verbal information or suggestion. Nocebo responses may come about through unintentional negative suggestion on the part of physicians and nurses. Information about possible complications and negative expectations on the patient’s part increases the likelihood of adverse effects. Adverse events under treatment with medications sometimes come about by a nocebo effect.

Conclusion: Physicians face an ethical dilemma, as they are required not just to inform patients of the potential complications of treatment, but also to minimize the likelihood of these complications, i.e., to avoid inducing them through the potential nocebo effect of thorough patient information. Possible ways out of the dilemma include emphasizing the fact that the proposed treatment is usually well tolerated, or else getting the patient’s permission to inform less than fully about its possible side effects. Communication training in medical school, residency training, and continuing medical education would be desirable so that physicians can better exploit the power of words to patients’ benefit, rather than their detriment.

Words are the most powerful tool a doctor possesses, but words, like a two-edged sword, can maim as well as heal.“, Bernard Lown (e1).

Doctor–patient communication and the patient’s treatment expectations can have considerable consequences, both positive and negative, on the outcome of a course of medical therapy. The positive influence of doctor–patient communication, treatment expectations, and sham treatments, termed placebo effect, has been known for many years (e2) and extensively studied (1). The efficacy of placebo has been demonstrated for subjective symptoms such as pain and nausea (1). The Scientific Advisory Board of the German Medical Association published a statement on placebo in medicine in 2010 (2).


The opposite of the placebo phenomenon, namely nocebo phenomena, have only recently received wider attention from basic scientists and clinicians. A search of the PubMed database on 5 October 2011 revealed 151 publications on the topic of “nocebo,” compared with over 150 000 on “placebo.” Stripping away from the latter all articles in which “only” placebo-controlled drug trials were reported left around 2200 studies investigating current knowledge of the placebo effect. In comparison, the data on the nocebo effect are sparse. Of the 151 publications, only just over 20% were empirical studies: the rest were letters to the editor, commentaries, editorials, and reviews (Figure).

Number of studies on the placebo effect

Our intention here is to portray the neurobiological mechanisms of nocebo phenomena. Furthermore, in order to sensitize clinicians to the nocebo phenomena in their daily work we present studies on nocebo phenomena in randomized placebo-controlled trials and in clinical practice (medicinal treatment and surgery). Finally, we discuss the ethical problems that arise from nocebo phenomena which may be induced by explanation of the proposed treatment in the course of the patient briefing and describe possible solutions.

Definition of nocebo phenomena

The term “nocebo” was originally coined to give a name to the negative equivalent of placebo phenomena and distinguish between desirable and undesirable effects of placebos (sham medications or other sham interventions, for instance simulated surgery). “Nocebo” was used to describe an inactive substance or ineffective procedure that was designed to arouse negative expectations (e.g., giving sham medication while verbally suggesting an increase in symptoms) (3).

“Placebo” and “nocebo” are meanwhile being used in another sense: The effects of every medical treatment, for example administration of drugs or psychotherapy, are divided into specific and non-specific. Specific effects are caused by the characteristic elements of the intervention. The non-specific effects of a treatment are called placebo effects when they are beneficial and nocebo effects when they are harmful.

Placebo and nocebo effects are seen as psychobiological phenomena that arise from the therapeutic context in its entirety, including sham treatments, the patients’ treatment expectations and previous experience, verbal and non-verbal communications by the person administering the treatment, and the interaction between that person and the patient (4). The term “nocebo effect” covers new or worsening symptoms that occur during sham treatment e.g., in the placebo arm of a clinical trial or as a result of deliberate or unintended suggestion and/or negative expectations. “Nocebo response” is used to mean new and worsening symptoms that are caused only by negative expectations on the part of the patient and/or negative verbal and non-verbal communications on the part of the treating person, without any (sham) treatment (5).

Experimental nocebo research

Experimental nocebo research aims to answer three central questions:

  • Are nocebo effects caused by the same psychological mechanisms as placebo effects, i.e., by learning (conditioning) and reaction to expectations?
  • Are placebo and nocebo effects based on the same or different neurobiological events?
  • Are the predictors of nocebo effects different from those of placebo effects?

Psychological mechanisms

The proven mechanisms of the placebo response include learning by Pavlovian conditioning and reaction to expectations aroused by verbal information or suggestion (6). Learning experiments with healthy probands have shown that worsening of symptoms of nausea (caused by spinning on a swivel chair) can be conditioned (7). Expectation-induced cutaneous hyperalgesia could be produced experimentally through verbal suggestion alone (8). Social learning by observation led to placebo analgesia on the same order as direct experience by conditioning (9).

Nocebo responses can also be demonstrated in patients. In an experimental study, 50 patients with chronic back pain were randomly divided into two groups before a leg flexion test: One group was informed that the test could lead to a slight increase in pain, while the other group was told that the test had no effect on pain level. The group with negative information reported stronger pain (pain intensity 48.1 [standard deviation (SD) 23.7] versus 30.2 [SD 19.6] on a 101-point scale) and performed fewer leg flexions (52.1 [SD 12.5] versus 59.7 [SD 5.9]) than the group with neutral instruction (10).

It can be concluded from these studies that both placebo and nocebo responses can be acquired via all kinds of learning. If such reactions occur in everyday clinical practice, one must assume that they arise from the patient’s expectations or previous learning experiences (5).

Neurobiological correlates

A key part in the mediation of the placebo response is played by a number of central chemical messengers. Especially dopamine and endogenous opiates have been demonstrated to be central mediators of placebo analgesia. These two neurobiological substrates have also been shown to play a part in the nocebo response (hyperalgesia): While secretion of dopamine and endogenous opioids is increased in placebo analgesia, this reaction is decreased in hyperalgesia (11). Because worsening of symptoms e.g., increased sensitivity to pain is often associated with anxiety, other central processes play a part, e.g., the neurohormone cholecystokinin (CCK) in pain (12). To date, a genetic predisposition to placebo response has been demonstrated only for depression and social anxiety (e3); such a predisposition to nocebo response has so far not been shown (e4).

Interindividual variation

Sex is a proven predictor of the placebo response and also exerts some influence on the nocebo response. In the above-mentioned study on the aggravation of symptoms of nausea, women were more susceptible to conditioning and men to generated expectations (6).

Identification of predictors of nocebo responses is a central goal of ongoing investigations. The aim is to pinpoint groups at risk of nocebo responses, for example patients with high levels of anxiety, and optimize the therapeutic context accordingly (13).

Generation of nocebo responses by doctor– patient and nurse–patient communication

The verbal and non-verbal communications of physicians and nursing staff contain numerous unintentional negative suggestions that may trigger a nocebo response (14).

Patients are highly receptive to negative suggestion, particularly in situations perceived as existentially threatening, such as impending surgery, acute severe illness, or an accident. Persons in extreme situations are often in a natural trance state and thus highly suggestible (15, 16). This state of consciousness leaves those affected vulnerable to misunderstandings arising from literal interpretations, ambiguities, and negative suggestion (Box).

Unintended negative suggestion in everyday clinical practice (after 15, e5, e6)

In medical practice the assumption is that the patient’s pain and anxiety are minimized when a painful manipulation is announced in advance and any expression of pain by the patient is met with sympathy. A study of patients receiving injections of radiographic substances showed that their anxiety and pain were heightened by the use of negative words such as “sting,” “burn,” “hurt,” “bad,” and “pain” when explaining the procedure or expressing sympathy (17). In another study, injection of local anesthetic preparatory to the induction of epidural anesthesia in women about to give birth was announced by saying either “We are going to give you a local anesthetic that will numb the area so that you will be comfortable during the procedure” or “You are going to feel a big bee sting; this is the worst part of the procedure.” The perceived pain was significantly greater after the latter statement (median pain intensity 5 versus 3 on an 11-point scale) (18).

The patient’s expectations

Just as the announcement that a drug is going to be given can provoke its side effects even if it is not actually administered, telling headache patients that they are going to experience a mild electric current or an electromagnetic field (e.g., from cell phones) produces headaches (e7). The symptoms of Parkinson’s disease patients undergoing deep brain stimulation are more pronounced if they know their brain pacemaker is going to be turned off than if they do not know (e8).

Nocebo phenomena in drug treatment

Researchers distinguish true placebo effects from perceived placebo effects. The true placebo effect is the whole effect in the placebo group minus non-specific factors such as natural disease course, regression to the mean, and unidentified parallel interventions. The true placebo effect can be quantified only by comparing a placebo group and an untreated group (19). The true nocebo effect in double-blind drug trials thus includes all negative effects in placebo groups minus non-specific factors such as symptoms from the treated disease or comorbid conditions and adverse events of accompanying medication (4). The nocebo effects in drug trials referred to below are perceived rather than “true” nocebo effects.

Adverse event profile and discontinuation rates in placebo groups of randomized trials

A systematic review showed that in randomized controlled trials (RCTs) of migraine (69 studies in total, 56 of them with triptans, 9 with anticonvulsants, and 8 with non-steroidal antirheumatic drugs), the side effect profile of placebo corresponded with that of the “true” drug being tested (20). A systematic review of RCTs of tricyclic antidepressants (TCAs; 21 studies) and selective serotonin reuptake inhibitors (SSRIs; 122 studies) revealed a significantly higher rate of adverse events in both the verum and placebo arms of the TCA trials compared to the verum and placebo arms of the SSRI trials. Patients given TCA placebos were significantly more likely to report dry mouth (19.2% versus 6.4%), vision problems (6.9% versus 1.2%), fatigue (17.3% versus 5.5%), and constipation (10.7% versus 4.2%) than patients taking SSRI placebos (21).

The side effects of medications therefore depend on what adverse events the patients and their treating physicians expect (20, 21). Rates of discontinuation owing to adverse effects of placebo in double-blind trials on patients with various diseases are presented in Table 1.

Table 1
Systematic reviews: discontinuation rates in placebo arms of randomized trials owing to adverse events

Problems in evaluating side effects of drugs

The methods used for recording adverse events influence the type and the frequency of effects reported: Patients specify more adverse events when checking off a standardized list of symptoms than when they report them spontaneously (21). In a large proportion of double-blind drug trials, the way in which subjective drug side effects were recorded is described inadequately or not at all (22). The robustness of the data on which summaries of product characteristics and package inserts are based must therefore be seen in a critical light.

The problems in evaluating side effects of drugs in RCTs also apply in everyday clinical practice. Is the symptom reported by the patient—nausea, for example—a side effect of medication, a symptom of the disease being treated, a symptom of another disease, or a (temporary) indisposition unconnected with either the drug or the disease?

Nocebo effects during drug treatment in everyday clinical practice

Nocebo effects have been described in (Table 2):

Table 2
Nocebo effects in clinical studies
  • Drug exposure tests in the case of known drug allergy
  • Perioperative administration of drugs
  • Finasteride in benign prostate hyperplasia
  • Beta-blocker treatment of cardiovascular diseases
  • Symptomatic treatment of fatigue in cancer patients
  • Lactose intolerance.

The lactose content of tablets varies between 0.03 g and 0.5 g. Small amounts of lactose (up to 10 g) are tolerated by almost all lactose-intolerant individuals. Therefore, complaints of gastrointestinal symptoms by lactose-intolerant patients who have been told by the physician or have found out for themselves that the tablets they are taking contain lactose may represent a nocebo effect (23).

In Germany, the aut idem ruling by which pharmacists may substitute a preparation with identical active ingredients for the product named on the prescription and discount agreements have led to complaints from patients and physicians of poor efficacy or increased adverse effects after switching to generic preparations. A cross-sectional survey conducted on behalf of the German Association of Pain Treatment (Deutsche Gesellschaft für Schmerztherapie e.V.) and the German Pain League (Deutsche Schmerzliga e.V.) questioned 600 patients who had been switched to an oxycodone-containing generic preparation. Ninety percent were less satisfied with the analgesic effect, and 61% reported increased pain intensity (German-language source: Überall M: IQUISP Gutachten [Fokusgruppe Oxycodonhaltige WHOIII Opioide] Querschnittsbefragung zu den psychosozialen Folgen einer Umstellung von Originalpräparaten auf Generika bei chronisch schmerzkranken Menschen im Rahmen einer stabilen/zufriedenstellenden Behandlungssituation. Überall M: IQUISP Expert Report [Focus Group Oxycodone-containing WHO III Opioids]: cross-sectional survey on the psychosocial consequences of substituting original preparations with generics for treatment of chronic pain in a stable/satisfactory treatment context [talk held on 8 March 2008 at a symposium sponsored by Mundipharma during the 19th German Interdisciplinary Pain Congress]).

A qualitative systematic review showed that patients with increased anxiety, depressivity, and somatization tendency are at greater risk of adverse events after switching to generic preparations (24). It must be discussed whether critical statements by medical opinion leaders (e22) and representatives of patients’ self-help organizations (e23) on the substitution of powerful opioid preparations by generic equivalents might not be leading to nocebo effects. In the words of one such statement: “The consequences of substitution are always the same: more pain or more adverse events” (e23).

Expectations that a treatment will be poorly tolerated, whether based on experience or induced by information from the media or trusted third parties, may bring about nocebo effects. A systematic review and meta-analysis found a robust association between the expectation and the occurrence of nausea after chemotherapy (e24).

Ethical implications and the dilemma of the patient briefing

On one hand physicians are obliged to inform the patient about the possible adverse events of a proposed treatment so that he/she can make an informed decision (e25). On the other, it is the physician’s duty to minimize the risks of a medical intervention for the patient, including those entailed by the briefing (25). However, the studies just cited show that the patient briefing can induce nocebo responses.

The following strategies are suggested to reduce this dilemma:

Focus on tolerability: Information about the frequency of possible adverse events can be formulated positively (“the great majority of patients tolerate this treatment very well”) or negatively (“5% of patients report…”) (4). A study on briefing in the context of influenza vaccination showed that fewer adverse events were reported after vaccination by the group told what proportion of persons tolerated the procedure well than by those informed what proportion experienced adverse events (e26).

Permitted non-information: Before the prescription of a drug, the patient is asked whether he/she agrees to receive no information about mild and/or transient side effects. The patient must, however, be briefed about severe and/or irreversible side effects (5). “A relatively small proportion of patients who take Drug X experience various side effects that they find bothersome but are not life threatening or severely impairing. Based on research, we know that patients who are told about these sorts of side effects are more likely to experience them than those who are not told. Do you want me to inform you about these side effects or not?” (5).

To respect patients’ autonomy and preferences, they can be given a list of categories of possible adverse events for the medication/procedure in question. Each individual patient can then decide which categories of side effects he/she definitely wants to be briefed about and for which categories information can be dispensed with (e27).

Patient education: A systematic review (four studies, 400 patients) of patients with chronic pain showed that training from a pharmacist—e.g., general information on medicinal and non-medicinal pain treatment or on the recording of possible side effects of drugs and guidance in the case of their occurrence—reduced the number of side effects of medications from 4.6 to 1.6 (95% confidence interval of difference: 0.7–5.3) (e28).


Communication training with actor-patients or role-plays during medical studies or in curricula for psychosomatic basic care impart the ability to harness the “power” of the physician’s utterances selectively for the patient’s benefit (e29, e30). Skill in conveying positive suggestions and avoiding negative ones should also receive more attention in nurse training.

The German Medical Association’s recommendations on patient briefing, published in 1990 (e25), urgently require updating. The points that need to be discussed include, for example, whether it is legitimate to express a right of the patient not to know about complications and side effects of medical procedures and whether this must be respected by the physician. Furthermore, it has to be debated whether some patients might not be left confused and uncertain by their inability to follow the legally mandatory comprehensive information on potential complications of medical treatments that is found, for example, on package inserts or multipage information and consent documents.

Conflict of interest statement
Dr. Häuser has received reimbursement of congress and training course fees and travel costs from Eli Lilly and the Falk Foundation, and lecture fees from Eli Lilly, the Falk Foundation, and Janssen-Cilag.
Prof. Hansen has received research funds from Sorin, Italy.
Prof. Enck declares that no conflict of interest exists.

Manuscript received on 28 January 2012, revised version accepted on 28 March 2012.

Translated from the original German by David Roseveare.

Corresponding author
PD Dr. med. Winfried Häuser
Klinik Innere Medizin 1, Klinikum Saarbrücken, Winterberg 1
66119 Saarbrücken, Germany

@For eReferences please refer to:

Hróbjartsson A, Gøtzsche PC: Placebo interventions for all clinical conditions. Cochrane Database Syst Rev 2010; (1): CD003974. MEDLINE
Wissenschaftlicher Beirat der Bundesärztekammer: Stellungnahme des Wissenschaftlichen Beirats der Bundesärztekammer „Placebo in der Medizin“. www.bundesaerztekammer.de/downloads/StellPlacebo 2010.pdf, Last accessed on 09 November 2011.
Kennedy WP: The nocebo reaction. Med World 1961; 95: 203–5. MEDLINE
Colloca L, Sigaudo M, Benedetti F: The role of learning in nocebo and placebo effects. Pain 2008; 136: 211–8. CrossRef MEDLINE
Colloca L, Miller FG: The nocebo effect and its relevance for clinical practice. Psychosom Med 2011; 73: 598–603. CrossRef MEDLINE
Enck P, Benedetti F, Schedlowski M: New insights into the placebo and nocebo responses. Neuron 2008; 59: 195–206. CrossRef MEDLINE
Klosterhalfen S, Kellermann S, Braun S, Kowalski A, Schrauth M, Zipfel S, Enck P: Gender and the nocebo response following conditioning and expectancy. J Psychosom Res 2009; 66: 323–8. CrossRef MEDLINE
Benedetti F, Lanotte M, Lopiano L, Colloca L: When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience 2007; 147: 260–71. CrossRef MEDLINE
Colloca L, Benedetti F: Placebo analgesia induced by social observational learning. Pain 2009; 144: 28–34. CrossRef MEDLINE
Pfingsten M, Leibing E, Harter W, et al.: Fear-avoidance behavior and anticipation of pain in patients with chronic low back pain: a randomized controlled study. Pain Med 2001; 2: 259–66. CrossRef MEDLINE
Scott DJ, Stohler CS, Egnatuk CM, Wang H, Koeppe RA, Zubieta JK: Placebo and nocebo effects are defined by opposite opioid and dopaminergic responses. Arch Gen Psychiatry 2008; 65: 220–31. CrossRef MEDLINE
Benedetti F, Amanzio M, Vighetti S, Asteggiano G: The biochemical and neuroendocrine bases of the hyperalgesic nocebo effect. J Neurosci 2006; 26: 12014–22. CrossRef MEDLINE
Mitsikostas DD: Nocebo in headaches: implications for clinical practice and trial design. Curr Neurol Neurosci Rep 2012; 12: 132–7. CrossRef MEDLINE
Hansen E, Bejenke C: Negative und positive Suggestionen in der Anästhesie – Ein Beitrag zu einer verbesserten Kommunikation mit ängstlichen Patienten bei Operationen. Anaesthesist 2010; 59: 199–209. CrossRef MEDLINE
Bejenke CJ: Suggestive communication: its wide applicability in somatic medicine. In: Varga K (ed.). Beyond the words: communication and suggestion in medical practice. New York: Nova Science Publishers 2011; 83–96.
Cheek D: Importance of recognizing that surgical patients behave as though hypnotized. Am J ClinHypnosis 1962; 4: 227–31. CrossRef MEDLINE
Lang EV, Benotsch EG, Fick LJ, et al.: Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 2000; 355: 1486–90. CrossRef MEDLINE
Varelmann D, Pancaro C, Cappiello EC, Camann WR: Nocebo-induced hyperalgesia during local anesthetic injection. Anesth Analg 2010; 110: 868–70. CrossRef MEDLINE
Ernst E, Resch KL: Concept of true and perceived placebo effects. BMJ 1995; 311: 551–3. CrossRef MEDLINE PubMed Central
Amanzio M, Corazzini LL, Vase L: A systematic review of adverse events in placebo groups of anti-migraine clinical trials. Pain 2009; 146: 261–9. CrossRef MEDLINE
Rief W, Nestoriuc Y, von Lilienfeld-Toal A, et al.: Differences in adverse effect reporting in placebo groups in SSRI and tricyclic antidepressant trials: a systematic review and meta-analysis. Drug Saf 2009; 32: 1041–56. CrossRef MEDLINE
Häuser W, Bartram C, Bartram-Wunn E, Tölle T: Systematic review: Adverse events attributable to nocebo in randomised controlled drug trials in fibromyalgia syndrome and painful diabetic peripheral neuropathy. Clin J Pain 2012; 28: 437–51. CrossRef MEDLINE
Vernia P, Di Camillo M, Foglietta T: Diagnosis of lactose intolerance and the „nocebo“ effect: the role of negative expectations. Dig Liver Dis 2010; 42: 616–9. CrossRef MEDLINE
Weissenfeld J, Stock S, Lüngen M, Gerber A: The nocebo effect: a reason for patients’ non-adherence to generic substitution? Pharmazie 2010; 65: 451–6. MEDLINE
Miller FG, Colloca L: The placebo phenomenon and medical ethics: rethinking the relationship between informed consent and risk-benefit assessment. Theor Med Bioeth 2011; 32: 229–43. CrossRef MEDLINE
Lown B: Die verlorene Kunst des Heilens. Stuttgart: Schattauer, 2004.
Beecher HK: The powerful placebo. J Am Med Assoc 1955; 159: 1602–6. MEDLINE
Furmark T, Appel L, Henningsson S, et al.: A link between serotonin-related gene polymorphisms, amygdala activity, and placebo-induced relief from social anxiety. J Neurosci 2008; 28: 13066–74. MEDLINE
Kaptchuk TJ, Kelley JM, Deykin A, et al.: Do „placebo responders“ exist? Contemp Clin Trials 2008; 29: 587–95. MEDLINE
Hansen E, Zimmermann M, Dünzl G: Hypnotische Kommunikation mit Notfallpatienten. Notfall Rettungsmed 2010; 13: 314–21. CrossRef
Hansen E: Negativsuggestionen in der Medizin. Z Hypnose Hypnother 2011; 6: 65–82.
Stovner LJ, Oftedal G, Straume A, Johnsson A: Nocebo as headache trigger: evidence from a sham-controlled provocation study with RF fields. Acta Neurol Scand 2008; 188 (Suppl): 67–71. MEDLINE MEDLINE
Mercado R, Constantoyannis C, Mandat T, Kumar A: Expectation and the placebo effect in Parkinson`s disease patients with subthalamic nucleus deep brain stimulation. Movement Disorders 2006; 21: 1457–11461. CrossRef
Rief W, Avorn J, Barsky AJ: Medication-attributed adverse effects in placebo groups: implications for assessment of adverse effects. Arch Intern Med 2006; 166: 155–60. MEDLINE
Papadopoulos D, Mitsikostas DD: Nocebo effects in multiple sclerosis trials: a meta-analysis. Mult Scler 2010; 16: 816–28. CrossRef MEDLINE
Mitsikostas DD, Mantonakis LI, Chalarakis NG: Nocebo is the enemy, not placebo. A meta-analysis of reported side effects after placebo treatment in headaches. Cephalalgia 2011; 31: 550–61. CrossRef MEDLINE
Liccardi G, Senna G, Russo M, et al.: Evaluation of the nocebo effect during oral challenge in patients with adverse drug reactions. J Investig Allergol Clin Immunol 2004; 14: 104–7. MEDLINE
Lombardi C, Gargioni S, Canonica GW, Passalacqua G: The nocebo effect during oral challenge in subjects with adverse drug reactions. Eur Ann Allergy Clin Immunol 2008; 40: 138–41. MEDLINE
de la Cruz M, Hui D, Parsons HA, Bruera E: Placebo and nocebo effects in randomized double-blind clinical trials of agents for the therapy for fatigue in patients with advanced cancer. Cancer 2010; 116: 766–74. CrossRef MEDLINE PubMed Central
Manchikanti L, Pampati VKim Damron K: The role of placebo and nocebo effects of perioperative administration of sedatives and opioids in interventional pain management. Pain Physician 2005; 8: 349–55. MEDLINE
Mondaini N, Gontero P, Giubilei G, et al.: Finasteride 5 mg and sexual side effects: how many of these are related to a nocebo phenomenon? J Sex Med 2007; 4: 1708–12. MEDLINE
Silvestri A, Galetta P, Cerquetani E, et al.: Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo. Eur Heart J 2003; 24: 1928–32. MEDLINE
Cocco G: Erectile dysfunction after therapy with metoprolol: the Hawthorne effect. Cardiology 2009; 112: 174–7. CrossRef MEDLINE
Cairns JA, Gent M, Singer J, et al.: Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med 1985; 313: 1369–75. MEDLINE
Myers MG, Cairns JA, Singer J: The consent form as a possible cause of side effects. Clin Pharmacol Ther 1987; 42: 250–3. CrossRef MEDLINE
Reeves RR, Ladner ME, Hart RH, Burke RS: Nocebo effects with antidepressant clinical drug trial placebos. Gen Hosp Psychiatry 2007; 29: 275–7. CrossRef MEDLINE
Resolution des Deutschen Schmerztages 2008. Sparmaßnahmen im Gesundheitswesen verletzen Grundrecht auf Leben und körperliche Unversehrtheit. www.schmerz-therapie-deutschland.de/pages/presse/2008/2008_03_08_PM_12_Resolution.pdf. Last accessed on 18 September 2011.
Koch M: Petitionsausschuss Deutscher Bundestag 9.5.2011. www.bundestag.de/dokumente/textarchiv/2011/34316512_kw19_pa_petitionen/index.html. Last accessed on 18 September 2011.
Colagiuri B, Zachariae R: Patient expectancy and post-chemotherapy nausea: a meta-analysis. Ann Behav Med 2010; 40: 3–14. CrossRef MEDLINE
Bundesärztekammer: Empfehlungen zur Patientenaufklärung. Dtsch Arztebl 1990; 87(16): 807–8. VOLLTEXT
O’Connor AM, Pennie RA, Dales RE: Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. J Clin Epidemiol 1996; 49: 1271–6. CrossRef MEDLINE
Dworkin G: The Theory and Practice of Autonomy. Cambridge, UK: Cambridge University Press; 1988.
Bennett MI, Bagnall AM, Raine G, et al.: Educational interventions by pharmacists to patients with chronic pain: systematic review and meta-analysis. Clin J Pain 2011; 27: 623–30. MEDLINE
Bosse HM, Schultz JH, Nickel M, et al.: The effect of using standardized patients or peer role play on ratings of undergraduate communication training: A randomized controlled trial. Patient Educ Couns; 2011 (epub ahead of print). MEDLINE
Bosse HM, Nickel M, Huwendiek S, Jünger J, Schultz JH, Nikendei C: Peer role-play and standardised patients in communication training: a comparative study on the student perspective on acceptability, realism, and perceived effect. BMC Med Educ 2010; 10: 27. CrossRef MEDLINE PubMed Central

 Date HTM PDF 
10 / 2015 10 35
9 / 2015 17 143
8 / 2015 13 36
7 / 2015 16 26
6 / 2015 13 54
5 / 2015 26 85
2015 279 844
2014 635 789
2013 617 834
2012 1.545 6.732
Total 3.076 9.199

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