Psychological contributors to pain before, during, and after endodontic procedures: A scoping review

Despite an increasingly biopsychosocial approach to pain management in healthcare, limited research exists on psychological features in dentistry including endodontic-related pain. This study aimed to identify the scope of evidence on the relationship of psychological variables to pain associated with dentistry specifically endodontics, as a first step towards addressing them for treatment.

This scoping review was conducted according to the JBI Manual for Evidence Synthesis. Literature searches were performed in MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Cochrane, and CINAHL, alongside grey literature sources, including ProQuest, ClinicalTrials.gov, and conference materials, reference lists, medRxiv pre-prints, EBSCO theses, and data from clinical trial registers such as ClinicalTrials.gov and Cochrane trials (via Ovid) (from inception to February 2025). Two independent reviewers screened records, and data extraction was cross-verified. The protocol was registered on Open Science Framework (DOI: 10.17605/OSF.IO/FSRJP).

Forty eight studies were included. Twelve broad psychological constructs were evaluated in relation to pre, during, and post-endodontic pain: 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 linked to anxiety. Procedural and post-procedural pain was consistently associated with anxiety, pain expectations, depression, and pain beliefs.

A variety of psychological factors have been investigated in relation to endodontic pain at different time-frames. 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. Identifying psychological contributors to endodontic pain can enhance pain prediction, patient communication, and clinical care strategies.