Patient perspectives on statin intolerance, attribution of the nocebo effect and use of N=1-interventions: a...

Statin-associated symptoms often occur under therapy, though N=1-interventions suggest most symptoms may not be attributable to the therapy itself and might be related to the nocebo effect. This study explores patient perspectives on statin intolerance, the nocebo effect and factors influencing participation in N=1-interventions.

We conducted qualitative online focus groups among patients with statin intolerance from a university hospital. Collection of data persisted until data saturation was reached. Analysis was performed following the principles of thematic analysis.

Eighteen patients (median age 65.5 [IQR 11.5] years; 56 % men) participated in four focus groups. While acknowledging the nocebo effect as a mental construct mainly driven by imagination, none attributed their symptoms to it. Participants cited early symptom onset, severity, initial optimism about statins, and symptom relief after discontinuation as reasons to dismiss the nocebo effect. Barriers to N=1-intervention participation included dissatisfaction with statins, contentment with current therapy, uncertainty about lipid goals during placebo phases, and concerns that short treatment periods might not trigger symptoms. Facilitators included early intervention, altruism, potential health benefits, and research importance. Patients emphasized the need for clear guidance, personalized results, peer comparison, communication on causes beyond the nocebo effect, and therapeutic options for managing symptoms.

Statin-intolerant patients perceive the nocebo effect as unrelated to their symptoms and feel inadequately informed. Focus on the neurobiological component of the nocebo effect and introduction of N=1-interventions early in the patient journey combined with personalized information including practical nocebo coping tools can facilitate participation in N=1-interventions.