الفهرس 
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Abstract
The International Association for the Study of Pain (IASP) defines pain as, ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
According to this definition, the word ‘pain’ may function as a negative suggestion or nocebo communication which elicits a subconscious change in a patient’s mood, perception or behavior. Therefore, the assessment of postoperative pain using negatively valenced, nocebo communications might be expected to adversely affect patient perceptions of their postoperative experience.
So, pain is a negative emotional experience that is modulated by a variety of psychological factors through different inhibitory systems. For example, endogenous opioids and cannabinoids have been found to be involved in stress and placebo analgesia. The pain experience can be changed from negative to positive through verbal suggestions, the opioid and cannabinoid systems are co-activated and these, in turn, increase pain tolerance.
Postoperative pain assessment remains a challenge to medical professionals and received much attention over the past decade. Effective management of postoperative pain remains an important indicator of the quality of care provided to patients.
Pain scales are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. Pain scales are based on self-report, observational (behavioral), or physiological data. Self-report is considered primary and should be obtained if possible. Pain scales are available for neonates, infants, children, adolescents, adults, seniors, and persons whose communication is impaired. Pain scores are sometimes regarded as ”The Fifth Vital Sign”. In clinical practice, the assessment of pain typically uses simple scales such as the numerical ratings score (NRS) which is considered as gold standard for postoperative pain assessment.
The aim of this study was to measure the degree of pain relief when assessed by the pain numerical scale compared to the comfort score. Also, to evaluate the effect of negative suggestions on hemodynamics, postoperative anxiety, postoperative pain relief and postoperative analgesic consumption.
The present study was carried out in Alexandria University Hospitals on 100 adult patients (50 patients in each group) scheduled for laparoscopic cholecystectomy under general anaesthesia in order to show the effect of positive and negative words in postoperative pain using two scales “ pain numerical scale and comfort scale”. This was optimized by proper preparation of patients by preoperative explanation and training about using two scales for each group and proper intraoperative analgesia.
• group I: Patients were trained preoperatively to use pain numerical scale score to judge the degree of pain in the postoperative period.
• group II: Patients were trained preoperatively to use comfort score to judge the degree of pain in the postoperative period
The Following Parameters Were Assessed in the Present Study:
• Hemodynamic Parameters: including heart rate (beats/ minute), systolic arterial blood pressure (SBP), diastolic arterial blood pressure (DBP) and peripheral oxygen saturation (SpO2%).
• Postoperative pain assessment: it was performed to every patient in the ward according to group assignment.
• Time to 1st requirement of analgesia: it was defined as the 1st time postoperatively of patients to require rescue analgesia.
• Total postoperative pethidine consumption: it was recorded during the 24 hour postoperative period.
• Postoperative anxiety: it was assessed one hour after surgery using Ramsay sedation score. Level 2, 3 were considered as optimum while level 1 were considered as anxious, restless or agitated. Number of patients in each category was recorded and compared.
All parameters were measured continuously and recorded before induction, immediately after recovery, then every hour in first 4 hours postoperatively then every 4 hours in the remaining 24 hours.
The mean heart rate values were statistically significantly higher in group I relative to group II at recovery (p value = 0.003) and the resting postoperative day except in last 24th hour, there was no statistically significant difference between the two groups.
Meanwhile, the systolic arterial blood pressure readings were statistically significantly higher in group I relative to groups II at recovery (p values = <0.001) and the resting postoperative day except in last 24th hour, there was no statistically significant difference between the two groups.
About the diastolic arterial blood pressure, there were no statistically significant changes in the diastolic arterial blood pressure during the postoperative study period between two groups.
Also there were no significant differences between the two groups as regards changes in the percentage of oxygen saturation.
While describing the degree of pain and sensation in the two groups, there was significant difference as when comparing pain and comfort, lower scores are found for the comfort score than their equivalent pain score.
Regarding the time to 1st analgesic consumption, it was statistically significantly shorter in group I (1.32 hours) compared to group II (3.12 hours) with a p value of 0.001.
While the total postoperative pethidine consumption was statistically significantly higher in group I (89.5 mg/24 hrs) when compared to group II (57.5 mg/24 hrs) with a p value of < 0.001.
On assessment of the level of postoperative anxiety examined by the Ramsay Sedation Score, it has been demonstrated that during the 1st postoperative hour, a higher percentage of patients in group I were categorized to have a score of 1 which describes patients as “anxious” compared to patients in group II. Likewise, more patients in group II were categorized to have a score of II and III which describes patients as “calm” compared to patients in group I. There were no detected postoperative side effects.