Moderating effect of pain sensitivity on dental anxiety: a randomized controlled cognitive-behavioral intervention...

Pain sensitivity is considered a stable characteristic that can influence the development of situational fears. It has been related to dental anxiety and expectation of pain before dental procedures. The objective of this analysis was to examine whether baseline pain sensitivity moderated the efficacy of an online cognitive-behavioral therapy (CBT) intervention for dental anxiety relative to an active control condition. Participants with high dental anxiety were recruited from a dental school clinic in the northeastern United States to participate in a randomized controlled trial. Patients were randomized to receive an online CBT intervention or a time- and attention-matched control intervention. Changes in dental anxiety were assessed using the Modified Dental Anxiety Scale (MDAS). Baseline pain sensitivity was measured by the Pain Sensitivity Index (PSI), which assesses the fearful appraisal of pain and expected consequences of pain. Participants completed questionnaires at baseline, and at 1- and 3-month follow ups. Linear mixed-effects model analyses using mean-centered interaction terms examined whether baseline levels of pain sensitivity moderated the treatment effect on dental anxiety. A total of 499 participants (70.6% female, 62% Black, Mean age = 49) were enrolled in the clinical trial and randomized to the CBT intervention (n = 329) or control condition (n = 170). Baseline pain sensitivity ratings between intervention group (Mean = 67.4, SD = 22.3) and control group (Mean = 67.6, SD = 24.2 did not significantly differ (t = - 0.10, p = 0.92). Baseline pain sensitivity significantly moderated the effect of the online CBT intervention on dental anxiety, such that participants with low pain sensitivity were significantly more likely to see reductions in dental anxiety when compared to those with high pain sensitivity, (F(1, 633) = 5.91, p = 0.015). Participants with lower pain sensitivity experienced the greatest benefit in terms of reduction in dental anxiety following an online CBT intervention. Individuals with high pain sensitivity may require more targeted interventions or higher intervention dose to achieve adequate reduction in dental anxiety.