Prevalence and factors associated with severe pre-operative pain among patients presenting for non-surgical root canal treatment in the national dental PBRN PREDICT endodontic study

Background: This study quantified severe pre-operative pain immediately prior to non-surgical root canal treatment (RCT) and identified associated factors among a large, diverse patient sample. Methods: This National Dental Practice-Based Research Network study involved 153 practitioners recruiting 1,722 patients over six months. Patients rated their pain (0–10 scale) immediately prior to RCT; scores ≥7 were classified as severe. Associations between severe pain and demographics, medications, temporomandibular disorders (TMD), psycho-social factors, and clinical assessments were analyzed using generalized estimating equations, accounting for practitioner clustering. Results: Among 1,722 patients, mean current pain was 3.4 (sd=3.1); 21 % of patients reported severe pain at the time of RCT. Four characteristics were associated with increased likelihood of severe tooth pain, in order of magnitude: any of the 4 diagnostic findings (sensitivities) (OR=5.49, p<.001); patient taking pain medications for the tooth in the 7 days prior to RCT (OR=3.52, p<.001); pain catrastrophizing score of 5 or greater (OR=2.85; p<.001); and screening positive for TMD (OR=1.53; p=.006). Radiolucency was the only characteristic significantly (p<.05) inversely associated with severe tooth pain at the time of RCT (OR=0.73, p=.04) in the full multiple regression model. Conclusion: Severe pre-operative pain is prevalent among RCT patients and apparently influenced by specific psychological and clinical factors. Practical Implications: Identifying predictors like catastrophizing and tooth sensitivity can help guide pre-treatment counseling and pain management to improve patient outcomes.