Pulpal pain (i.e. toothache) is the most commonly experienced pain in the region of the oral cavity, and there is considerable variability in the pain reports of toothache patients. Given the ubiquity of pulpal pain in dental practice and the amount of treatment devoted to its prevention and relief, surprisingly little is known concerning its sensory and affective characteristics. Like many other forms of clinical pain, there is low correspondence between results from biomedical findings and pain report. While the impact of psychosocial and biological factors on other types of clinical pain has received considerable scientific attention, the influence of these factors on pulpal pain remains relatively unexplored. The research proposed in this application will utilize well-validated psychophysical assessment techniques to evaluate the impact of physiological, biological, and psychological factors on pulpal pain. Specifically, the relationship of experimental pain sensitivity (physiological), gender (biological), and pain coping (psychological) to clinical pain will be investigated in patients experiencing symptomatic pulpitis. Twenty-five female and 25 male patients will be studied once prior to endodontic treatment and again approximately one week later, following endodontic treatment, and an equal number of pain-free control subjects will be studied twice at the same time interval. First, coping skills will be assessed, and pulpitis patients' clinical pain will be evaluated. Pain sensitivity will then be determined using a cross-modality thermal magnitude matching procedure. This procedure reduces intrasubject variability, thus increasing the ability to detect group differences. The results of this research will provide important information concerning factors which modulate acute orofacial pain, and may lead to more efficacious patient management. For example, patients exhibiting increased pain sensitivity may be instructed in specific coping skills which could reduce emergency visits, analgesic medication use, and other adverse effects of heightened pain reports. Additionally, pulpitis pain may serve as a useful clinical model for exploring pain regulatory systems, and will serve as the basis for future grant applications to investigate the neural mechanisms whereby physiological, biological, and psychological factors influence pain perception.
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