“Bulging Disc Nocebo Effect"
By Tommy Hoffman, Licensed Physical Therapist
Most people have heard of the “Placebo Effect” and have at least some idea on what it is and how it works, but not many people are familiar with the “Nocebo Effect”. While the placebo effect, when it occurs, yields a positive outcome (albeit a fake treatment), the nocebo effect yields a negative outcome often based off some belief or idea.
Think Sick, Get Sick
This “think sick, get sick” mentality can in my mind be quite “catchy”. As with many possibilities, the nocebo effect is ever present in the back pain community. It helps explain the back pain epidemic in this country and the enormous amount of money being spent every year searching for its’ solution.
With the amount of people I see involved in some sort of litigation for their back pain, and the countless others out on worker’s compensation or social security disability, it is no wonder the system will go broke in less than 10 years. This is a legitimate crisis that deserves proper attention. And the old ways of looking at back pain must be changed, or the same outcomes will be reached repeatedly time and again (definition of insanity).
I submit that every time a physician tells a client that he/she has a bulging disc or herniated disc based off an existing MRI, the potential is for that client to now become one of the many walking wounded seeking social security disability. My concern is that how many of these people are actually victims of the nocebo effect?
How Does the Nocebo Effect Impact a Bulging Disc?
Studies have already shown that MRI’s taken on asymptomatic people yield extremely high false positives for conditions of degenerative disc disease, bulging discs, and herniated discs of the lumbar spine. For some conditions, these false positives happened more than 50% of the time.
That being said, it becomes obvious that not all back pain can be easily explained via an MRI report, and in fact, a person who elicits an MRI with a false positive for a bulging disc may well elicit a genuine nocebo effect.
They will now walk around with back pain, and armed with a powerful belief that based off a current MRI, they are convinced they have structural damage in the lumbar spine that will not go away without surgery. As they did not feel their back pain would resolve before, it certainly is there to stay now.
These people will often have their perceived “condition” sending them spiraling out of control and down the path of no return. The nocebo effect has them locked into the belief that they have a serious condition when it was quite possible that without the MRI and the information on it, there back pain condition may well have resolved all on its own.
When properly diagnosed, a person presenting with back pain due to a bulging disc or herniated disc is real. And it can be serious. It must however be met with some skepticism and some measure of reserve before jumping to conclusions. Knowledge is power, and it is something that must be approached with caution or we risk possible condemnation for ourselves and others if not properly dispensed or accurately received.
Good Luck,
Tommy Hoffman, P.T.Tommy Hoffman
"Don't spend more time with bulging disc pain by not finding out the truth today!"