Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect.

While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects. In this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects. This masterclass briefly introduces the nocebo effect and its underlying mechanisms. It then traces the historical development of chiropractic, osteopathy, and physiotherapy, arguing that there was and continues to be an excessive focus on the patient's body. Next, aspects of clinical practice, including communication, the therapeutic relationship, clinical rituals, and the wider social and economic context of practice are examined for their potential to generate nocebo and other undesirable effects. To aid reflection, a model to reflect on clinical practice and individual professions through the 'prism' of nocebo and other undesirable effects is introduced and illustrated. Finally, steps are proposed for how researchers, educators, and practitioners can maximise positive and minimise negative clinical context.

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Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest DHS works at several osteopathic education institutions and has received consultancy fees from Altern Health Ltd., an enterprise developing digital therapeutics for pain management. OT receives fees for delivering courses on low back pain communication and podcasting. GR leads education programmes on placebo, nocebo effects, and contextual factors in healthcare to under- and postgraduate students along with private CPD courses. MM has received travel expenses and/or honoraria as an invited speaker regarding therapeutic relationship from San Diego Pain Summit, Physio Austria, and Münster University of Applied Sciences. DN has no conflicts of interests to declare in relation to this work. LR receives fees for delivering communication courses and is currently working on a research project funded by Pfizer. LV has received consulting fees from Lundbeck. JDR receives fees for delivering pain management courses.