Negative words on surgical wards result in therapeutic failure of patient-controlled analgesia and further release of cortisol after abdominal surgeries

Minerva Anestesiol. Jul-Aug 2008;74(7-8):353-65.


Background: The perception of pain is germane to the environmental stimuli. Nurses on surgical wards are the main contributor in influencing patients' psychophysiological fettle. The aim of the study was to investigate the effect of different words, negative or positive, from nurses on postoperative pain therapy with patient-controlled analgesia (PCA).

Methods: 1500 ASA I-II patients, who underwent abdominal hysterectomy, were screened and 771 were randomized into one of four groups. In the no words group (NW, N.=35), no words was delivered. The positive (PW, N.=248), partially negative (NW1, N.=241) and totally negative (NW2, N.=247) groups received corresponding words when treating with morphine PCA, the words were given singly at the 3(rd), 6(th), 12(th), 18(th) h and repeatedly at the 3(rd) and 6(th) h, and each group was redivided into six subgroups according to varying time points. Pain intensity, morphine consumption, side effects, overall sedation and satisfaction scores were recorded and plasma cortisol was tested.

Results: A total of 614 patients completed the study. Negative words expressed significant influence on pain therapy at the 3(rd) and 6(th) h after surgeries (P<0.01), and this effect was more convenient in repeatedly treated patients (P<0.001). Positive and the 12(th) and 18(th) h negative words displayed little role in pain management. Morphine consumption, side effects, satisfaction and cortisol level converted with the change of the pain intensity. No intergroup differences were observed in patients' overall conditions.

Conclusion: Negative words on surgical wards influenced postoperative pain management at the earlier period of time after abdominal surgeries associated with the HPA axis activation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analgesia, Patient-Controlled / psychology*
  • Female
  • Humans
  • Hydrocortisone / biosynthesis*
  • Hydrocortisone / blood
  • Hysterectomy*
  • Language*
  • Middle Aged
  • Pain, Postoperative / metabolism
  • Pain, Postoperative / psychology*
  • Pain, Postoperative / therapy*
  • Stress, Psychological / complications*
  • Treatment Failure


  • Hydrocortisone