JCDA - Canadian Dental Association

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Special Protection There’s nothing more special than your family. So protect them with a special type of life insurance. Available exclusively to dentists through the CDA’s insurance program, Basic Life Insurance provides special advantages. Obtain up to $2-million of economically priced term coverage and you’ll benefit from: Attractive options to enhance your protection Savings on premiums if you’re in excellent health and qualify for lower Special or HealthEdge rates Further savings when you purchase higher coverage amounts The expertise of uniquely skilled advisors when planning your coverage Call today for no-cost personal service, or learn more on-line. 1-877-293-9455 Ext. 5002 www.cdspi.com/basic-life Basic Life Insurance is a member benefit of the CDA and co-sponsoring provincial dental associations. The plan is underwritten by The Manufacturers Life Insurance Company (Manulife Financial). D E n T I S T S F I r S T 08-192 08/08
Clinical p r a c t i c E Effects of Psychological State on Pain Perception in the <strong>Dental</strong> Environment Marco L. Loggia, PhD; Petra Schweinhardt, MD, PhD; Chantal Villemure, PhD; M. Catherine Bushnell, PhD ABSTRACT Psychological factors have an important influence on pain perception. Both in the clinic and in experimental settings, distraction has been shown to reduce pain. Further, negative emotions increase pain, whereas positive emotions have the opposite effect. Other more complex psychological states alter the way we feel pain. For instance, empathy for another person who is suffering increases our own pain experience, and expectation of pain relief underlies much of the placebo effect. Neuroimaging studies show a physiological basis for psychological pain modulation, with activity in pain pathways altered by attentional state, positive and negative emotions, empathy and the administration of a placebo. The same psychological factors activate intrinsic modulatory systems in the brain, including those stimulated when opiates are given for pain relief. It is important for the dentist and patients to understand the influence of psychological state on pain transmission. Such an understanding will not only help patients learn how to participate in their own pain control, but will also help the clinician create a fostering environment. For citation purposes, the electronic version is the definitive version of this article: www.cda-adc.ca/jcda/vol-74/issue-7/651.html Most clinicians probably notice a dramatic difference among patients in terms of the pain they report during and after dental procedures. For example, when patients undergoing third molar extraction are allowed to vary their degree of sedation according to the amount of stress caused by the procedure (“patient-controlled sedation”), some make very few or no sedation requests, whereas others request sedation more than 60 times during the surgery. 1 Are some patients more demonstrative than others, or does the pain experience actually differ from person to person? A number of factors can contribute to a person’s pain experience, including genetic makeup, age, gender and life experiences, but one of the most important Contact Author Dr. Bushnell Email: catherine.bushnell @mcgill.ca factors is the individual’s psychological state at the time of the painful experience. In this article, we address how a patient’s psychological state can affect his or her pain perception and the neurophysiologic basis of the psychological modulation of pain. Despite a plethora of anecdotal accounts about people apparently experiencing little or no pain in situations that most of us would find intolerable, Western medicine generally fails to address a patient’s ability to modify pain, focusing instead on pharmacologic treatments. Consistent with this attitude, most research on pain control has targeted peripheral and spinal cord mechanisms of opioid and anti-inflammatory analgesic therapy. <strong>JCDA</strong> • www.cda-adc.ca/jcda • September 2008, Vol. 74, No. 7 • 651
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JCDA - Canadian Dental Association

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