Unravelling nocebo effect: the mediating effect of anxiety between anticipation and pain at wound dressing change

Aims and objectives The purpose of this study was to examine the mediating effect of anxiety in the relationship between anticipation and pain in people with chronic wounds. Background Pain is common in people with chronic wounds. Anticipation or negative expectation of discomfort has been shown to have an augmenting effect on pain; also known as nocebo hyperalgesia. Design This was a cross‐sectional study with repeated measures. Methods Prior to dressing change, anticipatory pain level was evaluated by a 11‐point numerical rating scale and anxiety by the Six‐items State‐Trait Anxiety Inventory (STAI‐6). During wound dressing changes, pain was measured before dressing removal, at dressing removal, at cleansing and dressing application using the numerical scale. Results Analysis was completed based on the data from a convenience sample of 96 patients. Participants reported more pain at cleansing and dressing removal than baseline. High levels of anticipation, anxiety and pain at dressing change for wounds were related to heavy exudate and wound that were covered with necrotic tissue. Finally, the relationship between anticipation and pain perception was mediated by anxiety. Conclusion Anticipation of pain triggers anxiety that can lead to increased pain. Relevance to clinical practice There is a need to incorporate evaluation of anxiety and personal expectations as part of comprehensive pain assessment. Clinicians should be aware of the impact of emotions and anticipation on overall pain experience.