Patients taking active medications frequently experience adverse, nonspecific
side effects that are not a direct result of the specific pharmacological
action of the drug. Although this phenomenon is common, distressing, and costly,
it is rarely studied and poorly understood. The nocebo phenomenon, in which
placebos produce adverse side effects, offers some insight into nonspecific
side effect reporting. We performed a focused review of the literature, which
identified several factors that appear to be associated with the nocebo phenomenon
and/or reporting of nonspecific side effects while taking active medication:
the patient's expectations of adverse effects at the outset of treatment;
a process of conditioning in which the patient learns from prior experiences
to associate medication-taking with somatic symptoms; certain psychological
characteristics such as anxiety, depression, and the tendency to somatize;
and situational and contextual factors. Physicians and other health care personnel
can attempt to ameliorate nonspecific side effects to active medications by
identifying in advance those patients most at risk for developing them and
by using a collaborative relationship with the patient to explain and help
the patient to understand and tolerate these bothersome but nonharmful symptoms.
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The Rational Clinical Examination EDUCATION GUIDESErythema Migrans
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