What Nocebo Is and the Evidence on Beliefs, Fear and Back Pain

Models built on adhesions, posture, weak cores or bones out of place are low-value care. They ignore the biopsychosocial model and can create nocebo effects. Nocebo is now seen as its own phenomenon: an inert treatment combined with suggestions that symptoms will worsen, such as warning that bending will make a disc pop out. Patients who expect to feel worse often do, and these thought viruses can last for years. Jarod cites Darlow's 2013 work showing clinicians have a considerable and enduring influence on the beliefs of people with low back pain, including a woman who ended a pregnancy because she believed her core was too weak. Darlow's 2015 study links negative assumptions to more pain and longer duration. Fear avoidance beliefs predict poor outcomes, and Jarod uses the FABQ in clinic. Negative beliefs are linked to more care seeking, greater disability and, as early as age 17, more disability. GPs with high fear avoidance beliefs order more imaging, referrals and medication.