Ethnic Differences in Pain Experience and Side-effects with Oral Surgery

Objective: This study examined the associations of pre-operative baseline pain and mood with post-operative pain (POP) and side effects (SE) in a multi-ethnic sample following Third Molar surgery. Methods: Forty-four healthy individuals (66% female; mean age=22) representing three ethnic groups (African American/AA, Asian/AS, non-Hispanic whites/W) underwent pre-operative psychosocial assessment and psychophysical testing of four pain modalities (heat pain/HP, pressure/PP, cold pressor/CP, temporal summation/TS) plus pre-operative mood and anxiety ratings. Participants had all four third molars extracted and recordings included all surgery transactions, medications, and duration. Participants documented pain and SEs for three days post-operatively. Analyses examined group differences of pre-operative measures, POP and SE. Results: Ethnic groups rated similar warmth, HP threshold and tolerance, but no statistical differences were found on experimental pain measures except for PP Ulna as AA reported higher pain (p = 0.04). Further examination of means showed that AAs rated higher CP intensity and suprathreshold ratings, lower tolerance for HP “ramp and hold,” TS at 44 and 46C whereas AS demonstrated higher tolerance on PP, TS, and CP. There were nominal differences on POP but AS and AA reported 2-4 times worse and more frequent SE than W with neuro-cognitive and physiological effects (p's<.05). Patterns of correlations were found between pre-operative mood scores and QST ratings with POP and SEs (p's<.01). Conclusion: Results suggest different post-operative SE profiles between non-Hispanic whites and minorities despite similar amounts of medication. Patterns of POP varied across 3 days, but AA and AS reported worse physiological and neuro-cognitive SE. Different associations emerged between pain sensitivity and psychological factors with POP and SE, suggesting potentially different underlying influences across groups. Further research is needed to understand mechanisms leading to such differences and how that might affect clinical care and recovery. Supported by:UFCD Student Summer Research Fellowship, American Pain Society, NIH NS55094.