The influence of pain catastrophising on the experience of persistent pain/discomfort following non-surgical root canal treatment
Aims
To (i) determine the prevalence and influence of pain catastrophising on pain/discomfort experience associated with teeth demonstrating periapical healing following non-surgical root canal treatment (NSRCT); (ii) investigate common descriptors for characterising the pain/discomfort sensation.
Methodology
A total of 198 patients (264 teeth) were examined clinically and radiographically 5–14 months after completion of NSRCT. All the radiographs were assessed by one observer and 33% were additionally examined independently by a pre-calibrated second observer. Each tooth was classified into complete, incomplete, uncertain healing and failed to heal groups. Detailed pain histories were obtained using the Short Form of the McGill Pain Questionnaire. The pain catastrophising score for each case was determined using the Pain Catastrophising Scale (PCS) questionnaire. Cohen’s kappa coefficients were calculated to assess intra- and inter-observer agreement on radiographic examination. Multiple logistic regression models were employed to investigate the association between prevalence of pain/discomfort and pain catastrophising as well as other potential influencing factors. Clustering effects within patients were adjusted using robust standard error.
Results
In total, 25% (n = 62/249) of teeth showing signs of periapical healing were associated with pain/discomfort on review. The most commonly used descriptors for the pain/discomfort sensation were ‘Sensitivity’, ‘aching’, ‘tender’ and ‘throbbing’. Intra- and inter-observer agreements were substantial (0.8 and 0.6, respectively). The PCS score had no significant association with pain/discomfort experience after NSRCT (OR = 1.3, 95% CI 0.3, 1.1). Significant factors affecting the prevalence of pain/discomfort included: history of chronic pain (OR = 3.5, 95% CI 1.5, 8.4); pre-operative vital pulp (OR = 5.2, 95% CI 1.5, 18.1); presence of pre-operative pain (OR = 2.9, 95% CI 1.1, 8.1); presence of a pre-operative crack (OR = 2.5, 95% CI 1.0, 6.3); and size of pre-operative periapical lesion (OR = 0.85, 95% CI 0.77, 0.95).
Conclusions
Twenty-five per cent of teeth showing signs of periapical healing had pain/discomfort characterised by typical descriptors; with five significant predicting factors. Pain catastrophising did not predict the occurrence of post-operative pain/discomfort. Further monitoring of the clinical course of prevalent pain/discomfort associated with periapical healing should inform future decision-making on further management.
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