Psychological Contributors to Pain Before, During, and After Endodontic Procedures: A Scoping Review

Background: Despite an increasingly biopsychosocial approach to pain management in healthcare, the scope of research into the role of psychological factors in endodontic pain is unknown. Objectives:This study aimed to identify the scope of research into psychological contributors to pain associated with endodontic procedures, as a first step towards addressing psychological contributors to pain in clinical practice. Method: This scoping review was conducted and reported according to the JBI Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (extension for scoping reviews). The data search was conducted in MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and CINAHL databases. For gray literature, we reviewed reference lists, medRxiv pre-prints, ProQuest and EBSCO theses, ClinicalTrials.gov and Cochrane trials (via Ovid), and conference materials via Web of Science and Scopus (from inception to July 2023). Each record was screened by two independent reviewers. Data were extracted by one reviewer and cross-verified by a second reviewer. Results: Forty studies were included in the review. Twelve broad psychological constructs were evaluated in relation to pain for pre-procedural, procedural and post-procedural endodontics: pain expectancies, positive treatment expectancies, depression, anxiety, positive and negative mood (affect), beliefs about pain, desire for control of dental treatments, perceptions of dentists, somatic focus or awareness, pain coping strategies, personality, and psychiatric diagnoses. Pre-procedural pain was most frequently associated with anxiety. Procedural pain was consistently associated with expected pain. Post-procedural pain was associated with expected pain, depression, beliefs about pain, positive treatment expectations, and personality characteristics. Conclusion: A variety of psychological factors have been investigated in relation to endodontic pain. Whilst associations between endodontic pain and psychological constructs were found, further research is needed to evaluate the strength of these associations, and the scope of evidence for interventions designed to address these psychological contributors to pain in dental practice. Registration: The search protocol was registered on Open Science Framework in 2021 (DOI number: 10.17605/OSF.IO/FSRJP).