title: Negative words on surgical wards result in therapeutic failure of patient-controlled analgesia and further release of cortisol after abdominal surgeries.
abstract: 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.
  
  
  CONCLUSIONS
  Negative words on surgical wards influenced postoperative pain management at the earlier period of time after abdominal surgeries associated with the HPA axis activation.
authors.affiliation: Department of Anesthesiology, Affiliated Nanjing Maternity and Child Health Care Hospital, Nanjing Medical University, Nanjing 210004, China. zfwang50@yahoo.com
authors.forename: F
authors.initials: F
authors.lastname: Wang
authors.forename: X
authors.initials: X
authors.lastname: Shen
authors.forename: S
authors.initials: S
authors.lastname: Xu
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: L
authors.initials: L
authors.lastname: Ma
authors.forename: Q
authors.initials: Q
authors.lastname: Zhao
authors.forename: D
authors.initials: D
authors.lastname: Fu
authors.forename: Q
authors.initials: Q
authors.lastname: Pan
authors.forename: S
authors.initials: S
authors.lastname: Feng
authors.forename: X
authors.initials: X
authors.lastname: Li
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000523:psychology*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000096:biosynthesis* / Q000097:blood; D007044:Hysterectomy; D007802:Language; D008875:Middle Aged; D010149:Postoperative Pain / Q000378:metabolism / Q000523:psychology* / Q000628:therapy*; D013315:Stress, Psychological / Q000150:complications*; D017211:Treatment Failure
chemical_list: D006854:Hydrocortisone