The effects of positive or negative words when assessing postoperative pain

Abstract

Negative or harsh words such as 'pain' and 'sting' used to describe sensations prior to potentially painful procedures have been shown to increase pain. We aimed to determine whether the reporting of pain and its severity is affected by the way it is assessed during anaesthesia follow-up after caesarean section. Following caesarean section, 232 women were randomised prior to post-anaesthesia review. Group N participants were asked questions containing the negative word 'pain', "Do you have any pain?" and then asked to rate it on a 0 to 10 point Verbal Numerical Rating Scale. Group P participants were asked questions using more positive words, "How are you feeling?" and "Are you comfortable?". Data are presented as median, interquartile range. In Group N, 63 participants (54.3%) reported pain compared with only 28 participants (24.1%) in Group P (P <0.001). There were no significant differences between groups for Verbal Numerical Rating Scale at rest: Group N 2 (0 to 3) vs Group P 1 (0 to 4); P=0.97, or Verbal Numerical Rating Scale with movement, Group N 5 (3 to 6) vs Group P 5 (3 to 6.3); P=0.90. The assessment of pain after caesarean section, using more positive words, decreases its incidence but does not affect its severity when measured by pain scores. Words that focus the patient on pain during its assessment may lead some to interpret sensations as pain which they might not do otherwise. These findings may have important implications when assessing and researching postoperative pain.