Potent Nocebo: The more expensive a harmless cream, the more pain it inflicts

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The mind is a powerful medicine. Given an ineffective treatment, patients can experience real health improvements by simply believing that the treatment works—the placebo effect. But this blissful delusion has a dark side: when a harmless placebo becomes effective, it becomes harmful, too, causing side-effects seen in actual therapies.

In a new study exploring this mysterious “nocebo effect,” researchers pinpoint regions of the brain that seem to be behind phantom injuries. They also assess factors—framing and price—that can increase the potency of the effect. These may be critical to designing and assessing clinical practices and trial results, they argue.

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. The researchers, led by neuroscientist Alexandra Tinnermann of University Medical Center Hamburg-Eppendorf, published the results recently in Science.