Cultural perceptions of pain and pain coping among patients and dentists

The mechanism and potential therapeutic target of piezo channels in pain

Pain is a common symptom of many clinical diseases; it adversely affects patients' physical and mental health, reduces their quality of life, and heavily burdens patients and society. Pain treatment is one of the most difficult problems today. There is an urgent need to explore the potential factors involved in the pathogenesis of pain to improve its diagnosis and treatment rate. Piezo1/2, a newly identified mechanosensitive ion channel opens in response to mechanical stimuli and plays a critical role in regulating pain-related diseases. Inhibition or downregulation of Piezo1/2 alleviates disease-induced pain. Therefore, in this study, we comprehensively discussed the biology of this gene, focusing on its potential relevance in pain-related diseases, and explored the pharmacological effects of drugs using this gene for the treatment of pain.

Exploring pain in the Andes--learning from the Quichua (Inca) people experience

There is a mounting recognition that culture profoundly shapes human pain experience. The 28 million indigenous people of the Andes in South America, mainly the Quichua (Inca) people, share a distinctive culture. However, little is known about their pain experience and suffering. The aim of the present study was to explore how Quichua adults perceive, describe, and cope with the pain. An exploratory qualitative/descriptive study was conducted with a convenience sample of 40 Quichua adults, including 15 women and 25 men, in the Northern Highlands of Ecuador. Data were collected through structured interviews of approximately 3 h, using a Quichua questionnaire called "The Nature of Pain" [Nanay Jahua Tapuicuna]. The interviews covered the notions of causation of pain, vulnerability to pain, responses to pain, aggravating factors, frequent locations of pain, types of pain, duration, characteristics of pain, control of pain, pathways to care, and preventive measures of pain. Basic descriptive analyses were performed. The Quichuas' pain experience is complex and their strategies to cope with it are sophisticated. According to the Quichuas, emotions, life events, co-morbid conditions, and spirits, among others factors play an important role in the origin, diagnosis, and treatment of pain. They strongly embrace biomedicine and physicians as well as Quichua traditional medicine and traditional healers. Family members and neighbors are also valuable sources of health care and pain control. The pathway to pain care that the Quichua people prefer is inclusive and pluralistic. The knowledge of the Quichua ethnographic "emic" details of their belief system and coping strategies to control pain are clinically useful not only for the health professional working in the Andes, some Quichua cultural characteristics related to pain could be useful to the culturally competent health practitioner who is making efforts to provide high-quality medical care in rural and multicultural societies around the world.

Effect of frequent laser irradiation on orthodontic pain. A single-blind randomized clinical trial

OBJECTIVE

To analyze the effect of low-level laser therapy (LLLT) on perception of pain after separator placement and compare it with perceptions of control and placebo groups using a frequent irradiation protocol.

MATERIALS AND METHODS

Eighty-eight patients were randomly allocated to a laser group, a light-emitting diode (LED) placebo group, or a control group. Elastomeric separators were placed on the first molars. In the laser and LED groups, first molars were irradiated for 30 seconds every 12 hours for 1 week using a portable device. Pain was marked on a visual analog scale at predetermined intervals. Repeated measure analysis of variance was performed for statistical analysis.

RESULTS

The pain scores of the laser group were significantly lower than those of the control group up to 1 day. The pain scores in the LED group were not significantly different from those of the laser group during the first 6 hours. After that point, the pain scores of the LED group were not significantly different from those of the control.

CONCLUSIONS

Frequent LLLT decreased the perception of pain to a nonsignificant level throughout the week after separator placement, compared with pain perception in the placebo and control groups. Therefore, LLLT might be an effective method of reducing orthodontic pain.

Prospective randomized clinical trial comparing the effects of a masticatory bite wafer and avoidance of hard food on pain associated with initial orthodontic tooth movement

INTRODUCTION

The purpose of this prospective, randomized clinical trial was to compare the use of masticatory bite wafers with the avoidance of mastication in reducing pain and discomfort associated with initial orthodontic tooth movement.

METHODS

Eighty-four subjects (mean age, 14.1 years), randomly allocated to a bite-wafer group (BWG) or a reduced-mastication group (RMG), completed the study. In each subject, 1 arch was bonded and ligated with a round austenitic active 0.016-in nickel-titanium wire, and placebo instructions were given. The subjects in the BWG then performed immediate supervised mastication of the wafers for 10 minutes, and they were instructed thereafter to bite on the wafers to prevent pain for the next 7 days. The subjects in the RMG were instructed not to masticate for 3 hours after placement of the fixed appliance and to avoid masticating hard food for 7 days. Each patient's level of anxiety was assessed before treatment with standard psychometric questionnaires. Each patient recorded the level of pain immediately after archwire ligation on a 100-mm visual analogue scale (VAS) and used a pain diary with a verbal rating scale for the next 7 days.

RESULTS

No statistically significant differences in the VAS immediately after ligation of the archwires were observed between the 2 groups. The median pain score for the BWG was higher for the first 4 days. The median peak difference was reached on the evening of the first day. At this maximum value, the median pain score of the BWG was higher and statistically significant (P = .006).

CONCLUSIONS

Although the amount of pain and discomfort reported by the patients undergoing fixed orthodontic therapy varied, more pain was reported by those using bite wafers than by those who avoided masticatory activity after placement of fixed appliances.).

A Comparison of Community and Physician Explanatory Models of AIDS in Mexico and the United States

The goal of this research was to explore differences between lay and professional explanatory models both within and between two countries. We test which effect is stronger, country of residence or professional/lay status, in determining similarities and differences of explanatory models of AIDS. Interviews conducted in Guadalajara, Jalisco (Mexico) and the Edinburg-McAllen area of south Texas (United States) elicited explanatory models of AIDS. Two pairs of samples were interviewed: a physician and community sample in Mexico and a physician and community sample in the United States. Comparisons of the explanatory models indicated that there was a shared core model of AIDS across all four samples, but that physicians' models were more similar to those of lay people in their own communities than either was to samples across the border.

Consensus analysis: reliability, validity, and informant accuracy in use of American and Mandarin Chinese pain descriptors

A quantitative method for validating qualitative interview results and checking sample parameters is described and illustrated using common pain descriptions among a sample of Anglo-American and mandarin Chinese patients and dentists matched by age and gender. Assumptions were that subjects were members of a sociocultural group (e.g. ethnic or professional/lay) and answered questions independently about a monotonic domain (e.g. pain). Subjects answered 18 true/false items derived from and selected to reflect pain perceptions consistent with published and unpublished interview data. Estimates of consistency in use of descriptors within groups, validity of description, accuracy of individuals compared with others in their group, and minimum required sample size were calculated using Cronbach's alpha, factor analysis, and Bayesian probability. Ethnic and professional differences within and across groups were also tested using multidimensional scaling (MDS) and hypothesis testing. Consensus (consistency of subject response by group) was .99 among Anglo-Americans and .97 among Chinese. Mean subject accuracy was .81 for Americans and .57 for Chinese, indicating the need for larger numbers of Chinese to supplement each others' statements. However, larger numbers of subjects were recruited than actually required for each ethnic group at .95 confidence limits. MDS showed similarities in use of descriptors within ethnic groups, while there were differences (p < .001) between Chinese and American groups. Use of covalidating questionnaires that reflect results of qualitative interviews are recommended in order to estimate sample parameters such as intersubject agreement, individual subject accuracy, and minimum required sample sizes.

Fear of injections and report of negative dentist behavior among Caucasian American and Taiwanese adults from dental school clinics

Fear of injections and reports of negative dentist behavior and associations with dental anxiety and avoidance of treatment were explored among 951 adults from dental school clinics in Iowa City, Iowa and Taipei, Taiwan. Use and fear of anesthetic injections and negative dentist behavior were assessed by written questionnaire to test associations with demographics, overall dental anxiety (Dental Anxiety Scale or "DAS") and utilization behaviors. Frequency and logistic regression analyses showed that use of dental anesthetics for routine treatment was much greater overall among caucasian Americans than Taiwanese, as was fear of injections. Taiwanese and Americans with high dental anxiety (DAS 12) had similar high fear of injections, but inspite of similar fears about dental drilling, high anxiety Taiwanese reported using much less local anesthesia for routine treatments than did high anxiety Americans. Report of condescending remarks to patients ("put downs") by dentists was mainly an American phenomenon associated with high dental anxiety. Avoidance of appointment making was high for persons afraid of injections and for Americans reporting negative dentist behavior. Avoidance was highest in subjects with high dental anxiety. That predominant characteristics or etiologies of dental anxiety can differ by cultural differences in dental health care systems, dentist beliefs and/or expectations of patients within those systems was discussed in relation to the literature.

Dentists' perceptions and management of pain experienced by children during treatment: a survey of groups of dentists in the USA and Finland

Dentists' perceptions and management of the pain experienced by children during treatment were examined in surveys of 198 American and 230 Finnish dentists. Two pain management areas were studied: communication and the use of anaesthetics and sedation. Neither group of dentists routinely questioned children about pain, but encouraging the child to report pain during treatment was more common; the USA dentists asked about pain more often than the Finnish dentists, whereas the Finnish dentists more often encouraged children to report pain. Finnish dentists were much less likely to use local anaesthetics during restorative treatment of either primary or permanent teeth than USA dentists. Neither group of dentists routinely prescribed nitrous oxide sedation, or premedication, or post-operative pain medications. Regarding the dentists' perceptions of pain experienced by children during dental treatment, neither group rated dental treatment procedures as particularly painful or unpleasant. Most dentists found the pain reports of children credible, yet a sizeable minority (up to 67% of the USA dentists and 21% of the Finnish dentists) did not find them strongly credible. There was little relationship between the dentists' pain management behaviour and their perceptions of the pain experienced by their patients.

Prevalence and characteristics of dental anxiety in Danish adults

Prevalence, characteristics and consequences of dental anxiety in a randomly selected sample of 645 Danish adults were explored in telephone interviews. Participation rate was 88%. Demographics, fear of specific procedures, negative dentist contacts, general fear tendency, treatment utilization and perceived oral conditions were explored by level of dental anxiety using a modified Dental Anxiety Scale (DAS). A Seattle fear survey item and a summary item from the Dental Fear Survey (DFS) were also included for fear description comparisons. Correlation between these indices (DAS-DFS: rs = 0.72; DAS-Seattle item: rs = 0.68) aided semantic validation of DAS anxiety intensity levels. Extreme dental anxiety (DAS > or = 15) was found in 4.2% of the sample and 6% reported moderate anxiety (DAS scores 14-12). Bivariate (B) and logistic regression (L) odds ratios (OR) showed that high dental anxiety was associated with gender, education and income, but not with age. Extreme dental anxiety for dentate subjects was characterized by fear of drilling (ORL = 38.7), negative dentist contacts (ORL = 9.3), general fear tendency (ORL = 3.4), avoidance of treatment (ORL = 16.8) and increased oral symptoms (ORB = 4.4). Moderate dental anxiety was also related to drilling (ORL = 22.3), but with less avoidance due to anxiety (ORL = 6.8) compared with low fear subjects.

Endodontology--epidemiologic considerations

The limited information available from endodontic epidemiologic research indicates an increase in prevalence of apical periodontitis with increasing age. Furthermore, apical periodontitis seems mainly to be present in connection with already endodontically treated teeth. This finding should be of particular concern since there is a discrepancy between the quality and results of endodontic therapy performed in general practice compared with the results obtained in specialty clinics. Pulpitis and acute apical periodontitis are main reasons for seeking emergency treatment and affect many people. Dental trauma frequently involving the dentin/pulp organ are likewise prevalent, affecting 30% of children and adolescents. Most information available regarding endodontic treatment is derived from well-controlled clinical studies performed by specialists. Epidemiologic data should be considered a necessary complement to this source of knowledge regarding etiologic factors and proper treatment procedures in order to improve the results of endodontic practice.

Ethnographic methodologic assessment of pain perceptions by verbal description

This study was designed to use known anthropologic methods to gather and analyze qualitative data about verbal descriptors of pain among 25 Chinese, and 60 Western subjects (25 Anglo-Americans and 35 Scandinavians). The sample consisted of 54 patients and 31 dentists. Key pain descriptors from each cultural context were selected for construction of pain assessment instruments which allowed multidimensional statistical techniques to translate these data into cross-cultural quantitative indices. Results revealed dimensions of pain which were universal in all cultures examined. These included time, intensity, location, quality, cause and curability. More culture-specific dimensions included the Chinese concept suantong, a multidimensional concept of bone, muscle, joint, tooth and gingival pain. 'Real' and 'imagined' pains were contrasts described by Western subjects, especially dentists; 'imagined pain' being the conversion of fear or anxiety into perceived pain. These data indicate that the data gathering and data analytic methods were reliable and sensitive to cultural variables and that ethnicity played a stronger role in determining perceptions of pain description than professional socialization for this population sample of Chinese and Western subjects.