In addition to beneficial side effects from the placebo, patients may also experience unwanted side effects such as headache, fatigue, or drowsiness. These harmful effects are termed nocebo effects. In 2002, Barsky et al. conducted a literature search of articles related to non-specific medication side effects, and they identified several factors associated with increased nocebo effect. These factors included patient expectation of adverse effects before beginning therapy, prior experiences of medication consumption leading to adverse symptoms, psychological co-morbidity such as depression or anxiety, and other situational factors. Patients who suffer from chronic pain are often characterized by several of these factors and are thereby at increased risk for nocebo effects (Barsky et al. 2002).
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