Does individual pain threshold influence postoperative pain after connective tissue graft surgery?

Postoperative pain and discomfort remain common concerns in periodontal plastic surgery involving gingival grafts; however, the influence of individual pain sensitivity on postoperative outcomes remains poorly understood. This study evaluated whether preoperative pain sensitivity is associated with postoperative pain intensity and analgesic consumption after coronally advanced flap (CAF) combined with subepithelial connective tissue graft (SCTG).

In this exploratory clinical study, 25 participants undergoing CAF + SCTG were assessed preoperatively for psychological factors (pain catastrophizing and fear of pain) and cold pain sensitivity using a cold pressor test. Cold pain threshold (CPT) and cold pain tolerance (CPTol) were determined by recording the time to pain onset and maximum tolerated immersion in cold water, with corresponding visual analog scale (VAS, 0-100) scores. Postoperative pain, discomfort, and analgesic intake at donor and recipient sites were recorded daily for 14 days using VAS-based diaries. Hierarchical and K-means clustering identified postoperative pain profiles, and binomial logistic regression evaluated predictors of cluster membership.

Two postoperative pain profiles were identified. Cluster 1 showed lower pain intensity and lower analgesic consumption, whereas Cluster 2 exhibited higher postoperative pain and greater analgesic use. Higher initial pain intensity during the cold pressor test significantly increased the odds of belonging to Cluster 2, with each unit increase associated with an approximately 11.2% increase in the odds of membership. In contrast, cold pain threshold, pain tolerance, and psychological variables were not associated with postoperative pain profiles.

Preoperative pain intensity during a cold pressor test may help identify patients at greater risk of postoperative pain after CAF + SCTG, suggesting a simple approach for preoperative risk stratification.

Assessment of individual pain sensitivity before surgery may help clinicians anticipate postoperative discomfort and tailor analgesic strategies to improve patient-centered outcomes following root coverage procedures.