Mobilio Nicola, Gremigni Paola, Pramstraller Mattia, Vecchiatini Renata, Calura Giorgio, Catapano Santo
Department of Prosthodontics, School of Dentistry, University of Ferrara, Ferrara, Italy.
J Oral Maxillofac Surg. 2011 Nov;69(11):2731-8. doi: 10.1016/j.joms.2011.05.023. Epub 2011 Aug 10.
To evaluate whether preoperative pain sensitivity testing and emotional perception of pain could explain the level of postoperative pain after lower third molar extraction.
Twenty-three patients (16 women, 7 men) scheduled for lower third molar extraction were enrolled in the study. Patients preoperatively were submitted to a nociceptive stimulus by a cold pressor test (immersion of the hand into ice water). Preoperative pain tolerance (seconds), algosity and unpleasantness (visual analog scale), and dental anxiety (Modified Dental Anxiety Scale) were assessed. The duration of surgery was recorded (minutes). Postoperative pain ratings were taken by self-reported registrations on a 100-mm visual analog scale during the 6 days after surgery. Separate stepwise regression analyses were performed to evaluate the usefulness of preoperative scores in explaining the overall maximum postoperative pain level and postoperative pain rates at different intervals.
Preoperative unpleasantness related to the nociceptive stimulus was found to be the best predictor of maximum postoperative pain (adjusted R(2) = 0.39, P = .001). Demographic information (age) and preoperative (dental anxiety, pain tolerance, algosity) and intraoperative (duration of surgery) factors were not correlated with postoperative pain.
These results show that a simple preoperative test is useful to identify patients at risk of developing greater pain after third molar surgery. They are characterized by a higher level of reported pain or unpleasantness after exposure to a nociceptive stimulus. This test may be tailored to specific patient needs for postoperative treatment.
评估术前疼痛敏感性测试和对疼痛的情绪感知是否能够解释下颌第三磨牙拔除术后的疼痛程度。
本研究纳入了23例计划行下颌第三磨牙拔除术的患者（16例女性，7例男性）。术前通过冷加压试验（将手浸入冰水中）对患者施加伤害性刺激。评估术前疼痛耐受性（秒）、疼痛强度和不愉快程度（视觉模拟量表）以及牙科焦虑（改良牙科焦虑量表）。记录手术时长（分钟）。术后通过患者在术后6天内以自我报告方式在100毫米视觉模拟量表上进行记录来评估疼痛评分。进行单独的逐步回归分析，以评估术前评分对解释术后不同时间段总体最大疼痛水平和术后疼痛发生率的有用性。
发现术前与伤害性刺激相关的不愉快程度是术后最大疼痛的最佳预测指标（调整R² = 0.39，P = 0.001）。人口统计学信息（年龄）以及术前（牙科焦虑、疼痛耐受性、疼痛强度）和术中（手术时长）因素与术后疼痛均无相关性。
这些结果表明，一项简单的术前测试有助于识别下颌第三磨牙手术后发生更严重疼痛风险较高的患者。这些患者的特征是在暴露于伤害性刺激后报告的疼痛或不愉快程度较高。该测试可根据患者术后治疗的特定需求进行调整。
