Association between psychological factors and pain perception in patients with symptomatic irreversible pulpitis during endodontic treatment

Aim: To investigate the association of pain perception of inferior alveolar nerve (IAN) block injection and access cavity preparation with psychological factors in patients undergoing endodontic treatment.

Methodology: In this observational study, out of 208 patients who had lower molar with symptomatic irreversible pulpitis, 165 patients completed the study. Psychological factors comprising anxiety, depression and personality traits were evaluated by Hospital Anxiety and Depression scale and short form of NEO Five-Factor Inventory. Procedural pain comprising needle insertion and anesthesia solution deposition during IAN block injection as well as access cavity preparation was rated based on the Heft-Parker visual analog scale. Binary logistic regression was used to determine odd ratio (OR) with 95% confidence interval (CI).

Results: The mean (standard deviation) age of patients was 34.63 (12.42) in which, females comprised 72.7% (n=120). Considering the psychological factors, the anxious and depressed individuals constituted 38.8 % and 32.7% of the participants, respectively. By adjusting the socio-demographic factors, depression score during needle injection and anesthetic solution deposition were the risk factors for higher levels of pain (OR=1.12; 95% CI=1.03_1.29 and OR=1.13; 95% CI=1.05_1.32 respectively). Among the personality traits, just neuroticism at needle insertion and anesthetic solution deposition associated with higher levels of pain (OR=1.11; 95% CI=1.02_1.28 and OR=1.09; 95% CI=1.01_1.20 respectively).

Conclusions: Coupling with the effect of physiological aspects (depression and neuroticism) on the perception of pain at the needle insertion and anesthetic solution during IAN block injection, a multidisciplinary effort both by dentists and by psychologists might improve dental services for some patients.