Clinical relevance of nocebo effects in anesthesia practice: a narrative review


nocebo, communication, anesthesia

Published online: Feb 27 2024

L. Cuyx1, S. Rex1,2

1 Department of Anesthesiology, University Hospital of Leuven, Leuven, Belgium
2 Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium


Background: Anesthesia practice has traditionally focused on technical skills and medical knowledge, but the importance of effective doctor-patient communication and patient-centered care is increasingly recognized. In this context, the nocebo effect is an important concept to be aware of as it can be associated with negative outcomes.

Objective: This review summarizes the neurobiological and psychological factors underlying the formation of nocebo effects. Additionally, the implications of nocebo effects in clinical practice will be explored. Finally, we will provide a brief overview of communication concepts relevant to the physician-patient relationship that can help minimize nocebo effects and serve as a useful guide for anesthetists to improve their communication skills and provide better care to their patients.

Methods: PubMed, Ovid and Cochrane library were searched using keywords related to “nocebo effect”, “anesthesia” and “communication”. In addition, we added articles found in references of identified articles relevant for our research.

Results: Nocebo effects can arise from a variety of factors, including negative expectations, negative wording and suggestions, and a poor doctor-patient relationship. While nocebo effects can deteriorate health outcomes, appropriate verbal and non-verbal communication can improve patient satisfaction and subsequently health outcomes.

Conclusion: In recent years, there has been an increasing recognition of the importance of doctor-patient communication in anesthesia practice. Communication strategies such as active listening, empathy, and positive language should be incorporated into anesthesia training programs. More research is needed to fully understand the impact of the nocebo effect on health outcomes and to develop effective strategies to mitigate its negative effects.