The sciatica nocebo effect is very strong and one of the worst possible negative consequences of the medical diagnostic process. Nocebo is a Latin word which means: I will harm. This word is the diametric opposite of placebo and therefore creates pain, fear, anxiety and suffering where none would be physically appropriate. The concept of nocebo explains why so many patients experience pain for the first time after a positive spinal abnormality diagnosis, or suffer an escalation of symptoms after confirmation of any significant diagnostic verdict.
This mindbody essay will account for the creation, perpetuation and exacerbation of symptoms due to pure psychological suggestion imparted during the diagnostic process.
The most common cause of the sciatica nocebo is the basic diagnostic process. The doctor finds some spinal abnormality and describes in vivid detail how this structural condition is the cause of great pain. Furthermore, the prognosis for the future is often painted as a grim picture, full of continuing suffering, progressive degeneration, ongoing treatment and commonly, eventual surgery. This utterance is like a sword to pierce the very heart of even the most brave and hopeful patient.
The doctor can play up the nocebo effect or can prevent it through their choice of words. Mistakes in how the diagnosis is delivered are simply an indication of poor bedside manner in some instances, but are purposeful attempts to initiate ongoing pain, and subsequent profitable treatment, in other circumstances.
The mindbody connection has been long established in all cases of chronic neck and back pain, whether or not there exists an actual structural causation for symptoms. The nocebo effect enjoys full power in patients who have an actual physical injury, since it may prevent the conscious mind from accepting the truth that the physical injury has long since healed.
The sciatica nocebo is even more powerful in psychosomatic syndromes, since it gives much needed credibility to the psychogenic symptoms, by mistakenly blaming them on some scapegoat condition in the spine.
The following is an ideal diagnosis and prognosis for sciatica in a perfect world:
Ok, Mr. Jones, I have looked at your MRI test results and I see that you have a herniated disc located at L5/S1. That is the bad news. The good news is that the disc is not affecting any nerves and your extensive sciatica symptoms are far too widespread to possibly come from that single spinal source anyway. After talking to you about your life, I am fairly confident that your pain is due to some stress and the tension it has produced in your anatomy. The pain should resolve with appropriate treatment. I recommend you read some knowledge therapy materials to help you understand how stress can cause you physical pain. Please call me if you have any questions, but I am quite certain you will be pain-free in a couple of weeks.
A more realistic medical approach avoiding the nocebo effect would be more like this:
Ok, Mr. Jones, You have a herniated disc at L5/S1. This might explain much of your pain, but not all of it. The symptoms are too widespread to come from this one disc. I think it is probably just some internal tension which has built up because of the structural disc pain. This disc is a very common site for a herniation and in fact, mine is herniated, as well. It has been for years. It hurts sometimes, especially when I am stressed, but it is not a chronic concern. I doubt you will have any major problem in the future. In fact, I think the worst of your symptoms are finished. I want you to go for some physical therapy and use some ice and heat a couple times a day for 6 weeks. You will be fine, Mr. Jones.
Unfortunately, this is the most common scenario:
Ok, Mr. Jones, I see you have a herniated disc at L5/S1. This is a very serious situation and is the cause of most long-term back pain conditions. This disc is nothing to play around with and it is crucial that we get you into treatment right away before any permanent damage is done. I want you to stay in bed for the next 2 weeks, then come see me about ongoing treatment. Also, please take 2 of each of these 6 different drugs every day. This is going to be a long hard road, Mr. Jones, but I will help to get you through it. I am a disc pain specialist and will make sure that when you need surgery, you will get the best care. In the meantime, take it easy and no vigorous activity. You have a real spinal problem and can not be too careful.
As a patient, I am sure you have seen situations very much like this last one. The doctor is not doing anything wrong, but still they are setting the stage for a chronic sciatica condition to take hold. Physical or psychosomatic cause is irrelevant at this point. Once the fear is in place, the mind will perpetuate the symptoms far into the future.
In my particular diagnostic case, I have generally received enough nocebo reactions to kill the average person. I have been warned that I am all of the following:
- irreparably damaged
- a surgical emergency
- suffering from advanced spinal deterioration
- in danger of paralysis
- going to need care for the rest of my life
These are all actual quotes from some of my many doctors and chiropractors. I can remember each perfectly as if they were pronounced yesterday. At the time, I was scared to death by these prognostic verdicts.
Now, looking back, I am entertained by them. Most were told to me over 20 years ago. They just go to prove the sciatica nocebo is alive and well in the back pain industry and that none of these doctors had a clue about what they were talking about.
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