Long-Term Association between Anxiety, and Analgesic Consumption and Postoperative Pain Experience in Norwegian Patients Following Surgical Removal of Third Molar Teeth

Thursday, October 10, 2013
Ellen C. Vigen MOdont, DiplSed&PainControl, Section of Dental Pharmacology and Pharmacotherapy, Faculty of Dentistry, ICD, University of Oslo, Oslo, Norway
Olaug Egeland CandOdont, Department of Maxillofacial Surgery, Oslo University Hospital (Ullevaal), Oslo, Norway
Gaute Lyngstad CandOdont, Section of Dental Pharmacology and Pharmacotherapy, Faculty of Dentistry, ICD, University of Oslo, Oslo, Norway
Lasse A. Skoglund CandOdont, DiplSed&PainContr, DSci, Section of Dental Pharmacology and Pharmacotherapy, Faculty of Dentistry, ICD, University of Oslo, Oslo, Norway
Per Skjelbred PhD, MD, CandOdont, Department of Maxillofacial Surgery, Oslo University Hospital (Ullevaal), Oslo, Norway
Anders Skoglund BSc, Section of Dental Pharmacology and Pharmacotherapy, University of Oslo, Oslo, Norway

Statement of problem:

Gender moderates pain experience where females had a lower pain threshold and were less tolerant to pain than males. Less is known about postoperative self-medication and swelling.

Purpose:

The purpose of this pilot trial was to investigate if gender could influence the association between preoperative dental anxiety, postoperative analgesic tablet consumption and pain in Norwegian patients during a 7 day period following third molar surgery.

Materials and Methods:

Twenty-seven (15 females/12 males) consecutive Norwegian patients of ASA class I-II participated. Mean ages (SD) females/males were 29.5 (7.4)/32.7 (10.7) years, heights were 168.6 (5.4)/179.9 (6.0) cm, and weights were 59.3 (7.2)/ 80.7 (12.2) kg. A single third molar with at least one previous history of acute pericoronitis were removed using a buccal envelope flap and local anesthesia (lidocaine 2% + adrenalin 1:80 000) only. Patient consent and Norwegian Ethical Committee approval was obtained prior to trial. The patients scored their level of dental anxiety on Corah's Dental Anxiety Scale (CDAS) just prior to surgery, and their subjective pain intensity (PI) every hour up to 12 hours after completing surgery, including the exact time patients took analgesic drugs for the first time on a 0-10 numerical rating scale (NRS). PI was scored at 8:00, 12:00, 16:00 and 20:00 hours every day for 6 days after the day of surgery. The patients had access to OTC analgesics ad libitum restricted only by the maximum daily dose regimen specific of each drug. Every tablet intake including type and dose during the observation period was noted.

Data analysis:

Mean group data including specifics of the surgical procedures were calculated. Differences between data were analyzed by the Independent Samples T-Test, and Pearson's correlation coefficients were computed with the Bivariate Correlations Test (IBM© SPSS© Statistics release 20.0.0). The level of 2-tailed statistical significance was P<0.05, and equal variances were not assumed for group data.

Results:

Mean (SD) females/males time of the day when surgery ended was 12:49 (2:05)/11:41 (2:18) hours. The corresponding volumes of local anesthetic were 2.7 (0.27)/3.2 (0.5) ml. Times used for obtaining effect of local anesthetic were 2.2 (1.3)/4.5 (4.1) min, and times used for surgery were 16:32 (8:39)/15:05 (5:35) min:sec. Females and males differed with respect to height and weight (P=0.000), and volume of local anesthetic used (P=0.029). The numerical difference in time for local anesthetic effect was not statistically significant (P=0.88). CDAS scores were 8.5 (3.3)/7.4 (2.6), times to first drug intake 2:50 (2:26)/3:35 (2:02) hrs:min, PI at the first drug intake 4.8 (2.9)/4.7 (2.1), sum tablets over 7 days 7.0 (7.2)/5.7 (4.0), sum PI over 7 days 79,7 (46.8)/48.9 (35.6). None of these numerical differences were statistically significant. The difference with respect to the sum of tablets taken over 7 days showed, however, a tendency to be significant (P=0.063). The correlation analyses for both genders together showed no statistically significant correlations. Analyses within the male group showed statistically significant correlations regarding CDAS score and the PI at the first drug intake, r=0.767, P=0.004, and the sum PI over 7 days r=0.593, P=0.042. There was a slight tendency for a statistically significant correlation in the female group between CDAS and sum tablets over 7 days, r=0.448, P=0.094 only.

Conclusion:

This limited pilot study suggests that there are gender based associations between preoperative anxiety, and postoperative subjective pain experiences and analgesic self-medication during a 7 day observation period after surgical removal of third molars.

References:

Corah NL, Pantera RE. Controlled study of psychological stress in a dental procedure. J Dent Res 1968;47:154-7.

Vaughn F, Wichowski H, Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN J 2007;85:589-604.

 

 

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