The placebo and nocebo effects in functional urology

• Published in: Nature reviews. Urology Vol. 19; no. 3; pp. 171 - 189
• Main Authors: Mostafaei, Hadi, Jilch, Sandra, Carlin, Greta Lisa, Mori, Keiichiro, Quhal, Fahad, Pradere, Benjamin, Laukhtina, Ekaterina, Schuettfort, Victor M., Aydh, Abdulmajeed, Sari Motlagh, Reza, Roehrborn, Claus G., Shariat, Shahrokh F., Hajebrahimi, Sakineh
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.03.2022; Nature Publishing Group
• Subjects: 692/4025/2021; 692/699/2768/1337; 692/699/2768/1575; 692/699/2768/515; 692/700/565; Clinical outcomes; Clinical trials; Female; Humans; Lower Urinary Tract Symptoms; Male; Medicine; Medicine & Public Health; Nocebo Effect; Placebo Effect; Review Article; Treatment Outcome; Urology
• ISSN: 1759-4812; 1759-4820
• DOI: 10.1038/s41585-021-00545-2

A placebo is an inert substance normally used in clinical trials for comparison with an active substance. However, a placebo has been shown to have an effect on its own; commonly known as the placebo effect. A placebo is an essential component in the design of conclusive clinical trials but has itself become the focus of intense research. The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. Randomized controlled trials in functional urology have demonstrated the importance of the placebo and nocebo effects across different diseases such as overactive bladder, urinary incontinence, lower urinary tract symptoms and interstitial cystitis/painful bladder syndrome, as well as male and female sexual dysfunction. Understanding the true nature of the placebo–nocebo complex and the scope of its effect in functional urology could help urologists to maximize the positive effects of this phenomenon while minimizing its potentially negative effects. The placebo effect is partly the result of positive expectations of the recipient on the state of health. Conversely, a nocebo effect is when negative expectations from a substance lead to poor treatment outcomes and/or adverse events. In this Review, the authors describe and discuss the placebo and nocebo effects in selected benign urological diseases. Key points Placebo and nocebo effects have major roles in functional urological ailments. The mechanisms by which the placebo and nocebo effects function are not fully understood. The pontine micturition centre might be affected by positive and negative expectations through a cascade of events resulting in improvement or worsening of functional urological symptoms. Clinicians need to consider the placebo and nocebo phenomena when managing a patient with a functional urological ailment. Clinicians should be trained regarding the placebo and nocebo effects with the aim of maximizing the benefits of the placebo effect and minimizing the harms of the nocebo effect. An individualized approach and shared decision-making should be performed when dealing with placebo and nocebo effects, as each individual has different perceptions with regard to placebo and nocebo phenomena.