Association between pain, anxiety, and pain relief in patients receiving emergent endodontic treatment.

OBJECTIVES: The experience of pain relief is closely associated with the affective-cognitive processing of hedonic value. Higher pain relief plays a key role in patients' satisfaction with treatment and higher motivation to receive treatment. Previous studies focused on pain and anxiety of endodontic treatment. However, the association between pain relief, pain, and anxiety has not been investigated. MATERIALS AND METHODS: We investigated 35 patients (20 females and 15 males, with mean age 46.3 years old) with symptomatic irreversible pulpitis receiving emergent endodontic treatment. Pain-related experience, including pain relief, pain, and anxiety, was assessed before and after treatment, based on an 11-point numerical scale. RESULTS: We found that before treatment, the expected pain relief (median score = 8) that one anticipated was positively correlated with the degree of pain reduction perceived after treatment (two-tailed rho = 0.51, p = 0.002). Expected pain relief was also positively correlated with the post-treatment relief (two-tailed rho = 0.76, p < 0.001) and the relief recalled after 6 weeks (two-tailed rho = 0.69, p < 0.001). Moreover, logistic regression models revealed that expected pain relief was a significant predictor of the subgroups of low vs. moderate scores of post-treatment pain (B = - 1.06, p = 0.017) and anxiety (B = - 1.60, p = 0.009), controlled for the condition of pre-treatment medication. CONCLUSIONS: The current findings highlight that for patients with symptomatic irreversible pulpitis who received emergent endodontic treatment, their expected pain relief before treatment is a critical factor associated with pain reduction and post-treatment pain/anxiety. CLINICAL RELEVANCE: Assessment of expected pain relief may be integrated into pre-treatment assessment for painful dental patients.

Magnification of fear and intention of avoidance in non-experienced versus experienced dental treatment in adults.

BACKGROUND: Dental fear is associated with the experience of prior dental treatment and avoidance of dental visits. It remains unclear if individuals show an intention of avoidance (IA) towards treatments that they have not received (i.e., non-experienced dental treatment). The study aims to investigated (a) if individuals showed an increased fear and IA to non-experienced, compared to experienced dental treatment, and (b) if fear and IA to non-experienced treatment is associated with dental anxiety. METHODS: Fear/IA of 12 common conditions of dental treatment of 402 adults were investigated. If subjects have experienced the condition, fear and IA were assessed based on subjects' prior experience (i.e., ExpFear/ExpIA). If they have not experienced the condition, fear and IA were assessed based on their anticipation (i.e., NExpFear/NExpIA). Trait dental anxiety was assessed using the Index of Dental Anxiety and Fear (IDAF-4C+). RESULTS: (A) NExpFear and NExpIA were significantly higher than ExpFear and ExpIA, respectively. (B) The IDAF-4C+ scores are positively correlated with NExpFear/NExpIA and negatively correlated with the magnification of fear (i.e., the discrepancy in the fear/IA of non-experienced vs. experienced conditions). (C) The condition 'extraction of a wisdom tooth' and 'root canal treatment' showed the highest ratings on NExpFear. CONCLUSIONS: Individuals may develop a high degree of fear and IA of the treatment they have not received. Trait dental anxiety plays a key role in the fear of non-experienced treatment.

The anterior insula and anterior cingulate cortex are associated with avoidance of dental treatment based on prior experience of treatment in healthy adults.

BACKGROUND: Fear concerning stressful medical or dental procedures is one of the major factors that distance patients from health care. Fear and avoidance of dental treatments can be shaped by a patient's prior experience with receiving dental procedures or by imagining the procedures. METHODS: We performed two functional magnetic resonance imaging (fMRI) experiments to investigate the role of the anterior insula (aINS) and dorsal anterior cingulate cortex (dACC), which are both critical to threat perception, in dental avoidance. Dental avoidance based on both prior treatment experience and imagination was assessed using a customized questionnaire. In an fMRI task-based study, we investigated brain activation in 17 healthy participants when they viewed images depicting dental procedures that evoked a moderate degree of fear. Region-of-interest analysis was performed to assess the association between dental avoidance and aINS as well as dACC activation. In a resting state fMRI study, we investigated 18 healthy participants for the association between the intrinsic functional connectivity of the aINS and dACC and dental avoidance. RESULTS: We found that (1) the participants showed a higher activation of the right aINS and bilateral dACC when they viewed images of dental procedures compared with the brain activation observed when they viewed scrambled images (p < 0.05 corrected for small volume and family-wise error). (2) The avoidance ratings based on prior experience of dental treatment were significantly positively correlated with the activation in the right aINS (r = 0.67, p = 0.003), right dACC (r = 0.65, p = 0.005) and left dACC (r = 0.63, p = 0.007). (3) The intrinsic functional connectivity between the aINS and the orbitofrontal cortex was positively correlated with the avoidance ratings based on experience (uncorrected p < 0.001). CONCLUSIONS: The findings highlight prior experience of dental treatment as a predominant factor in shaping patients' avoidance behavior. Individual differences in threat perception may play a key role in the development of dental avoidance.

Preferences for Analgesic Treatments Are Influenced by Probability of the Occurrence of Adverse Effects and the Time to Reach Maximal Therapeutic Effects.

Research on shared medical decision-making suggested that both the potency of a treatment and the probability of it being successful influence individual treatment preferences. Patients also need to consider the negative attributes of treatments, such as the occurrence of adverse effects or a slow start to the therapeutic effects. It remains unclear how these attributes influence individual treatment preferences. We investigated how the analgesic effect, the adverse effect, and the time-course effect influenced the preference of analgesic treatments. Forty-five healthy volunteers participated in three hypothetical analgesic decision-making tasks. They were instructed to imagine that they were experiencing pain and choose between two hypothetical analgesic treatments: the more potent radical treatment and the less potent conservative treatment. The potency of a treatment was countered by the following attributes: the probability of working successfully, the probability of inducing an adverse effect, and the time required for the treatment to reach its maximal effect. We found that (a) when the overall probability that a treatment would induce an adverse effect decreased, the participants changed their preference from a conservative treatment to a radical treatment; (b) when the time-course for a treatment to reach its maximal effect was shortened, the participants changed their preference from a conservative treatment to a radical treatment, and (c) individual differences in prior clinical pain and the degree of imagined pain relief were associated with preferences. The findings showed that the adverse effects and the time course of treatments guide the analgesic treatment preferences, highlighting the importance of sharing information about negative attributes of treatments in pain management. The findings imply that patients may over-emphasize the occurrence of adverse effect or a slow time-course of treatment effect. In terms of shared medical decision-making, clinicians should clarify these negative attributes related to treatment to patients.