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Nocebo-Induced Hyperalgesia During Local Anesthetic Injection

Varelmann, Dirk MD, DESA*; Pancaro, Carlo MD†; Cappiello, Eric C. MD*; Camann, William R. MD*

doi: 10.1213/ANE.0b013e3181cc5727
Obstetric Anesthesiology: Brief Report

Common practice during local anesthetic injection is to warn the patient using words such as: “You will feel a big bee sting; this is the worst part.” Our hypothesis was that using gentler words for administration of the local anesthetic improves pain perception and patient comfort. One hundred forty healthy women at term gestation requesting neuraxial analgesia were randomized to either a “placebo” (“We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure”) or “nocebo” (“You are going to feel a big bee sting; this is the worst part of the procedure”) group. Pain was assessed immediately after the local anesthetic skin injection using verbal analog scale scores of 0 to 10. Median verbal analog scale pain scores were lower when reassuring words were used compared with the harsher nocebo words (3 [2–4] vs 5 [3–6]; P < 0.001). Our data suggest that using gentler, more reassuring words improves the subjective experience during invasive procedures.

Published ahead of print December 30, 2009

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital; and †Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts.

Accepted for publication November 15, 2009.

Published ahead of print December 30, 2009

Supported by departmental funding.

Address correspondence and reprint requests to William R. Camann, MD, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115. Address e-mail to

© 2010 International Anesthesia Research Society
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