Dental Psychology: Pain - Coursework Example

Dental Psychology Introduction Pain is a common complaint in dental settings. It may be defined as an unpleasant sensory or emotional experienceassociated with actual or potential tissue damage, or described in terms of such damage (WHO). It is experienced by everyone regardless of age, gender or economic status. Being a multidimensional and complex phenomenon, it requires an interdisciplinary approach to assessment and intervention. Assessment of factors that influence pain in the dental clinic of Dr Drillette The first and foremost aspect that will be assessed is the environment of the dental room. This will include the appearance of the equipment, the color of the walls, sounds in the room, blood and other wastes from previous procedure and cleanliness. The next aspects will be about the dentist and his assistant’s attitude, appearance and presentation and dentist-patient interaction. Under this, the appearance of the health professionals will be noted like whether they are shabby looking, whether they have a pleasant and warm appearance, whether they appear confident and also whether they are able to communicate effectively. Details will be noted about how the dentist deals with his patients prior to the procedure. The assessment will also include about educating the patient prior to procedure as to what is the nature of the procedure, how long it will take, will the patient be comfortable during the procedure and what are the means of reducing pain. Also, assessment will be made whether these aspects are communicated effectively. The next step in the assessment would be to see how the medical professionals help allay pain and anxiety during the procedure other than the use of medications. This would include what are the distraction techniques used and whether any cognitive methods are used to allay anxiety. Post procedure assessment would include whether the patient was comfortable through the procedure or he/she would like any changes in the next session. Psychological factors influencing the perception of pain during treatment To understand pain, it is important to know the various psychological factors that affect pain. There are many theories which are put forward to understand pain. The most popular theories are the Specificity theory, the Pattern theory and the Gate Control theory. According to the Specificity theory, the damaged nerve fibers in our bodies send direct messages through the specific pain receptors and fibers to the pain center, the brain which causes the individual to feel pain (Adams and Bromley, 1998). Hence, the intensity of pain is directly related to the amount of associated tissue injury. However, this theory could not explain chronic pain and ‘phantom limb’ pain. According to the Pattern theory, pain is felt as a consequence to the amount of tissue damaged and nerve fibers that carry pain signals can also transmit messages of cold, warmth and pressure (Adams and Bromley, 1998). Both Pattern theory and Specificity theory do not include psychological aspects of pain and hence can not be appreciated. The Gate Control theory, also referred to as biopsychosocial model takes into account psychological factors of pain experiences. This theory supports the fact that experiences of pain are influenced by many physical and psychological factors such as beliefs, prior experience, motivation, emotional aspects, anxiety and depression. It claims that pain may be experienced without any physical injury and individuals interpret pain differently even though the extent of injury is the same and that pain does not occur at the site of injury, it is experienced in the nervous system, notably the brain (Melzack 1993). The experience of pain is a function of physical, psychological and environmental factors operating in concert with each other. This theory in further reinforced by the neuromatrix theory of pain according to which pain is a multidimensional experience produced by characteristic "neurosignature" patterns of nerve impulses that are generated by a widely distributed neural network that can be called the "body-self neuromatrix" and which is located in the brain. The ‘neurosignature’ is produced by sensory inputs (visual, temperature, tactile and other sensory inputs that influence cognitive interpretation), emotional inputs, intrinsic neural inhibitory modulation and the activity of the stress-regulation system (endocrine, autonomic, immune, and opioid systems) (Melzack 2002). There are multiple psychological factors that affect both the perception of pain and an individuals ability to cope with it. The major psychological factors that affect chronic pain are cognitions and incentives. Cognitive factors impact pain by modifying its interpretation and adversely affecting it. Anxiety intensifies such symptoms as myalgias and neuropathic pain. Phobic processes have been implicated on a cycle of unnecessary self-protection, leading to deconditioning. Chronic stress not only increases the perception of pain but also increases disability (Scheman 2005). Pain management in a dental room involves both physical and psychological pain. The four types of dental fear are fear of specific stimuli, distrustful of dental personnel, generalized anxiety and fear of medical catastrophe (Heaton, “Psychology of Dental Fear”). The most stated single cause for dental anxiety is an early negative dental experience (van Wijk 2005). According to the latent inhibition theory, a history of positive neutral dental experiences may serve as a buffer against the development traumatic associations or experiences. People who are predisposed to respond fearfully to pain are at an increased risk of ending up in a vicious circle of anxiety, fear of pain, and avoidance of dental treatment (van Wijk 2005). Pain is as much a cognitive and emotional construct as a physiological experience. Younger subjects and those with higher levels of education were more likely to report pain than older subjects and those with a lower educational level (Maggirias 2002). The need for psycho-social interventions like psychotherapy, relaxation training, support groups, counseling, education, mood management like cognitive behavior therapy and motivation, along with physical treatment of the disease or injury has been stressed upon because psychological interventions have a direct effect on the neural pathways that control the experience of pain. One of the critical therapies that can be provided to a patient is education. It is important to educate a person who is suffering from or going to suffer from pain because, a patient’s behavior and their family’s reaction to the disease may be based on faulty information or misconceptions. Hence education can clarify the problem and indicate the best response. Biofeedback, relaxation training, self-hypnosis and progressive muscle relation all have been shown to be effective in the treatment of pain by having a direct effect on tense and painful muscles and also reduce levels of stress hormones (Scheman 2005). Changes proposed to Dr. Drillette’s dental practice The first change that would be required in Dr. Drillette’s dental room would be change in appearance. The jargon of glittering surgical equipment should be covered because these could trigger a sense of operation-room like feeling amongst the patients and worsen their anxiety. Worsening anxiety means increased perception of pain. Also, the room can be made to look more pleasant by adding beautiful colors, paintings and curtains. Cleanliness is one aspect which all patients would observe. Removal of blood and other wastes from the previous procedure from the site would help. Pleasant soothing music in the room would be a great idea. The next step would be in the appearance, presentation and attitude of the health professionals in the clinic, i.e., the doctor himself and his assistant. They should wear pleasant clothes, communicate with smile and confidence and exhibit professionalism. They must have concern to the patients and Dr.Drillette should do his job of talking to the patient rather than just making his assistant do this for him. This will establish dentist-patient relationship and will enhance confidence in the doctor. It is important to encourage the patient to participate in decisions about treatment so that the patient gets a feeling of control and will feel much better. The dentist should discuss all the procedures which will be performed on the patient and ask whether the patient would like it to be done in one sitting or several sittings. The dentist should also discuss the types of pain control available and suggest which is the best suitable for the patient so that the patient feels that he/she is getting the best individualized treatment. During the procedure, the dentist must explain as to what is happening at every stage of the procedure so that the patient knows what the dentist is about to do next and the patient will be prepared and will not be taken by surprise. There may be a subset of patients who believe "ignorance is bliss" and they would like not to know what is happening with them during the procedure. With such patients, the dentist may behave accordingly. Patients should be allowed and encouraged to discuss their fears. They must be told that fears are not uncommon and that they are not the only people suffering from pain. One of the ways to reduce stress and decrease pain during a dental procedure is to distract the patient with something more pleasant. The patient can be provided with head phones and allowed to listen to their favorite music. Hearty talking and joking can also decrease pain. Also, the dentist himself should behave pleasantly and present himself well. Relaxation techniques also may be used to decrease pain during procedures and also to bring down the levels of anxiety. The principle behind relaxation techniques is that whenever the body goes through stress or anxiety, it releases hormones like adrenaline which causes tightening of muscles, increased heart rate and increased rate of breathing. This hormone also makes the pain receptors in the brain more sensitive. All these make the patient more uncomfortable and make him/her more fearful and anxious. Relaxation techniques reduce levels of stress hormones as well as pain and anxiety. Some of the commonly used and effective relaxation techniques are (“Oral and Dental Health Basics.”): 1. Guided imagery — In this technique, the dentist helps you imagine having a pleasant experience or being in a soothing environment. The idea is to create as much mental detail of the patient as possible so that the patient will become so involved in the mental images that he/she is hardly aware of what the dentist is doing. 2. Deep breathing — Also called diaphragmatic breathing, this technique involves breathing slowly and deeply. By this method, the body is flooded with oxygen and other chemicals that relax the central nervous system and help reduce discomfort. 3. Progressive relaxation — This technique involves conscious relaxation of each muscle of the body starting with the toes and moving all the way up to the head (or vice versa). Such progressive relaxation reduces muscular tension, which can help to reduce pain. Post procedure, the dentist must ask how the patient feels following the procedure and if the patient would like any changes during the next sessions. This is because; dental treatments usually involve many sittings and the most stated single cause for dental anxiety is an early negative dental experience. This way, the patient will be able to exhibit the fears, anxiety and discomfort he/she underwent during this session and the dentist can try and modify his approach in the following sessions and also inform the same to the patient. The above modifications need to be enforced in Dr. Drillette’s clinic for atleast one month and changes in the anxiety and pain levels of the patients noted. If there is a positive reaction from the patient, then Dr.Drillette needs to enforce these changes permanently. References Adams, B. & Bromley, B. (1998). Psychology for Health Care: Key terms and Concepts. USA: Macmillan Press Ltd. Heaton, L. Psychology of Dental Fear-part 2. Retrieved on 14th October 2007 from: http://72.14.209.104/search?q=cache:Bt4M7yWL5FIJ:faculty.washington.edu/jacksond/os532/slide_show/fear_06_2.pdf+dental+psychology&hl=en&ct=clnk&cd=12&gl=in Maggirias, J., Locker, D. (2002). Psychological factors and perceptions of pain associated with dental treatment. Community Dent Oral Epidemiol. , 30(2), 151-9. Melzack, R. (1993). Pain: Past, Present and Future. Canadian Journal of Experimental Psychology, 47(4), 615-629 Melzack, R. (2002). Evolution of pain theories. Program and abstracts of the 21st Annual Scientific Meeting of the American Pain Society: March 14-17, Baltimore, Maryland. Abstract 102. Scheman, J., Covington, E. (2005). Psychological Factors in Pain. Spinal Column. Fall, Cleveland Clinic Spine Institute (CCSI). Retrieved on 14th October 2007 from: http://cms.clevelandclinic.org/spine/documents/SpinalColumnF05.pdf van Wijk, A.J., & Hoogstraten, J. (2005). Experience with Dental Pain and Fear and Dental pain. J Dent R, 84(10): 947-950. Retrieved on 14th October 2007 from: http://jdr.iadrjournals.org/cgi/reprint/84/10/947.pdf Read More