Massage Therapy Journal Fall 2025

Fall 2025 • 73

As with placebo effects, nocebo effects are not just psychological. Recent research posits that nocebo responses in particular might be due to altered activation of the anterior cingulate cortex (ACC). The ACC has several functions, including pain perception and processing. With the nocebo effect, researchers suggest the ACC may be reinforcing negative anticipation, meaning side effects arise to alert a person to potential risk. A review 2 explored both placebo and nocebo effects in the treatment of migraines to offer a summary of the current understanding on the topic. The review includes citations from 111 studies, reviews and articles on the topic, and suggests that integrating the understanding of contextual effects like placebo and nocebo into clinical practice has important implications for optimizing the effectiveness of treatments by limiting nocebo effects and enhancing placebo effects. “[They] make up a significant part of the therapeutic experience … By addressing modifiable contextual factors such as patient expectations, lifestyle choices and the therapeutic relationship, health care providers can enhance the effectiveness of migraine treatment,” researchers noted. “A significant percentage of pain relief may be attributed to patients being informed about how their new drug treatment will likely impact their headache, thus channeling an effective placebo response.” In other words, positive treatment expectation can potentially be associated with better treatment outcomes. So what does all of this mean for massage therapists? For one, making sure your clients have good, reliable information around the benefits of massage therapy alongside open communication are key. Some benefits of massage therapy are well established in research. What might be worth deeper consideration is the role placebo effect might have in the massage experience and where leaning into more robustly explaining evidence

based practice to clients may help extend existing benefits. Or, alternatively, introduce potential for side effects via the nocebo effect. The possible implications for massage therapy center how clients are prepared before a massage session starts, mainly in how practitioners both talk to clients about their role in the massage session and the potential benefits. Massage therapists who take the time to explain to clients how various massage techniques work or may work and what they should or should not expect—including those that might be harder to explain with solid research— might increase the overall benefits experienced by that client. While there is still a lot to be understood about both placebo and nocebo effects, the more information a massage therapist has on the topic, the more likely they will be to provide clients with successful and beneficial massage sessions, holistic or otherwise. References 1. Parlak MM, Bizbinar Ö, Köse A. “The Effect of Holistic Therapy in Alzheimer’s Disease.” Altern Ther Health Med . 2023 Apr;29(3):52-59. 2. Basedau H, Ornello R, Matteis ED, et al. “Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects?” Cephalalgia . 2023;43(12). 3. Tang B, Barnes K, Geers A, Livesey E, Colagiuri B. “Choice and the Placebo Effect: A Meta-analysis.” Ann Behav Med. 2022 Oct 3;56(10):977-988. 4. Türkmen H, Çetinkaya S, Kiliç H, Tuna SD, Şirvanci M, Mutlu H. “The Effect of Ice Massage Applied to the SP6 Point on Labor Pain, Labor Comfort, Labor Duration, and Anxiety: A Randomized Clinical Trial”. J Midwifery Womens Health . 2024 Jul Aug;69(4):491-498. 5. Mooventhan A, Nivethitha L, Yogapriya C, Kahlilsubramanian K, Manavalan N. “Effect of Ice Massage to Abdomen on Blood Glucose Level and Cardiovascular Function in Healthy Individuals: A Single-group Pre-test and Post-test Experimental Study.” Int J Ther Massage Bodywork . 2024 Dec 12;17(4):43-48.

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