Recollection of pain intensity subjective

A patient’s recollection of pain associated with a medical or dental procedure may be more intense than the pain actually experienced, a new report has found.

The report, published in the Journal of Pain, suggests that the negative recollection associated with a dreaded visit to a dentist, periodontist or doctor may have more to do with how emotionally stressed the patient was during the experience rather than how much pain he or she endured at the time.

“The emotional state of a subject strongly influences the amount of pain the person recalls,” Henrietta L. Logan, director of the University of Florida College of Dentistry’s division of public health service and research, said yesterday in a telephone interview.

Ms. Logan, who was also the co-investigator of the study, added that this phenomenon becomes increasingly relevant the more time has elapsed since the procedure.

Ms. Logan’s research colleague, Jeffrey J. Gedney, a pain-behavior research fellow in the dental college’s division of public health service and research, put it this way:

“Clearly, many dental and medical procedures are aversive and anxiety-provoking, fear-provoking and uncomfortable, in general. What we found was that emotional factors became a better predictor over time of what people would recall than was their level of pain during the experience.”

Mr. Gedney added: “We’re trying to tweak out how long does it take for this exaggeration [of pain] to happen and the degree of exaggeration that occurs. … It seems to be a matter of several months.”

In earlier research, the University of Florida scientists found that recalled pain two weeks after patients underwent root canals was about the same as what they described on the day of the procedure. “Eighteen months later, we found anxiety was the biggest predictor of how much pain they recalled,” said Ms. Logan.

The latest University of Florida research was designed to measure how much stress — such as the normal anxiety one may have when a patient is about to undergo a root canal, mammogram or a colonoscopy — influences how painful people remember their experience being.

The Florida researchers found that subjects who were stressed during a painful experience recalled more pain after six months than they reported at the time of the event. They also found that women remembered more pain than men.

Robert Baron, a professor of psychology at the University of Iowa, said these findings demonstrate the importance of health care providers recognizing and treating “not just the clinical symptoms of disease, but the emotional reactions of patients during treatment.”

“Failure to do so will often heighten the patients’ negative recollection of treatment stress, which, in turn, will be likely to discourage them from seeking follow-up or continued treatment,” Mr. Baron said.