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More nocebos + degenerative hair disease

 •  • by Paul Ingraham
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I recently wrote about “nocebo”: the worsening of symptoms from fear and pessimism. And nocebo may often be caused by healthcare professionals who explain problems to their patients in dramatic and exaggerated ways: “nocebic language.”

Many readers submitted their own examples, significantly improving my own list of nocebo examples in musculoskeletal, sports, and pain medicine. So this is the expanded list — still modest, but growing.

  • “It’s just bone-on-bone in there.” (Some interesting data on this one: “Once the participants in this study had been ‘diagnosed’ with ‘bone-on-bone’ changes, many disregarded exercise-based interventions…”).
  • “Your intervertebral disc has slipped.”
  • All women over 50 have bad shoulders, that’s just how it is.”
  • “Keep going like you are and that tendon is going to rupture.”
  • “You’re hip was butchered by your last surgeon.”
  • I’m glad it’s not me!
  • “Your core is weak.”
  • “You’ll never play tennis with this shoulder again.”
  • “That meniscus is shredded.”
  • “You’re only 20, but you have the back of an 80-year-old.”
  • “I’ve never seen anything like this before!”

Note that all of these things have actually been said to patients, some of them far too often (“slipped disc”), others more rarely but disastrously (“butchered”). And it isn’t a definitive list of Bad Things to Say, but rather a list of candidates and usual suspects, word choices that are often accused of being nocebic — some much more justifiably than others, but this is not an exact science.

Let’s keep building the list. For instance, I’d love to add more examples about weirder pain issues, like A Rational Guide to Fibromyalgia. Have you been told something by a healthcare professional that seemed like a harmful exaggeration? Or just an unnecessarily scary way of explaining the truth? Keep ’em coming.

One other nice nocebo addendum …

Degenerative hair disease?

The take-home message of that nocebo post was not that these “scary” statements are inherently dangerous to people: it’s mostly how and when they are used that really counts, and most can be used much more safely with proper handling. And there are also often good alternatives that are more honest, educational, and gentle. For instance, a reader sent me this great example of creative, whimsical use of language for explaining arthritis…

“Age-related change” in joints is an obvious euphemism for arthritic degeneration. However, “degeneration” implies more worrisome pathology than is necessary or helpful, and so we probably shouldn’t say (or imply) that joints are “degenerating” any more than we would tell someone with gray hair that they have degenerative hair disease, or tell someone with wrinkles that they have degenerative skin disease. While degenerating joints obviously exist and certainly are nasty at times, we can and do live with arthritis much more peacefully than most people realize.

That analogy is a great way to say everything that matters: cute, clever, and functional.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher