[Treatment Expectations in the Perioperative Setting - Influence on Postoperative Pain Treatment]

Treatment expectations are relevant modulators of postoperative pain and recovery. In perioperative care, patients' expectations are shaped by previous experiences, verbal information, social learning, and the therapeutic context. Positive expectations may enhance analgesic effects via placebo mechanisms, whereas negative expectations may increase pain and reduce treatment efficacy via nocebo mechanisms.For anaesthetists, this offers a practical opportunity to improve perioperative pain management. During the preoperative consultation, patients can be asked about the intensity of pain they expect after surgery. Strongly negative expectations should prompt a targeted discussion of fears, previous negative experiences, and misconceptions. Balanced, empathic communication may help foster realistic positive expectations without compromising informed consent. In the postoperative phase, particularly in the recovery room, open administration of analgesics accompanied by clear and reassuring explanations of their expected effects, as well as consistent communication within the medical and nursing team, may further strengthen patients' confidence in their treatment and support postoperative pain control.Interventions combining empathic physician communication with structured information or digital visualization tools have shown beneficial effects on postoperative pain and opioid consumption. Thus, expectation management should be understood as an adjunct to evidence-based perioperative analgesia. By systematically assessing and realistically aligning expectations, anesthesiologists can help reduce nocebo effects, support placebo-related analgesia, and improve patient-centered outcomes.