Expertise Modulates Students' Perception of Pain From a Self-Perspective: Quasi-Experimental Study

Overview

Journal J Med Internet Res

Publisher JMIR Publications

Specialty Medical Informatics

Date 2019 Jan 25

PMID 30674449

Authors

Sareh Said Yekta-Michael

Andre Schuppen

Arnim Johannes Gaebler

Jens Ellrich

Jan Willem Koten

Affiliations

Soon will be listed here.

Abstract

Background: Perception of stimuli presented in a virtual dentistry environment affects regions of the brain that are related to pain perception.

Objective: We investigated whether neural correlates of virtual pain perception are affected by education in dentistry.

Methods: In this functional magnetic resonance imaging study, a sample of 20 dental students and 20 age-matched controls viewed and listened to video clips presenting a dental treatment from the first-person perspective. An anxiety questionnaire was used to assess the level of dental anxiety. Neural correlates of pain perception were investigated through classic general linear model analysis and in-house classification methods.

Results: Dental students and naïve controls exhibited similar anxiety levels for invasive stimuli. Invasive dentistry scenes evoked a less affective component of pain in dental students compared with naïve controls (P<.001). Reduced affective pain perception went along with suppressed brain activity in pain matrix regions including the insula, anterior cingulate cortex, and basal ganglia. Furthermore, a substantial reduction of brain activity was observed in motor-related regions, particularly the supplementary motor area, premotor cortex, and basal ganglia. Within this context, a classifier analysis based on neural activity in the nucleus lentiformis could identify dental students and controls on the individual subject level in 85% of the cases (34 out of 40 participants, sensitivity=90%, specificity=80%).

Conclusions: Virtual dental treatment activates pain-related brain regions in controls. By contrast, dental students suppress affective and motor-related aspects of pain. We speculate that dental students learn to control motoric aspects of pain perception during their education because it is a prerequisite for the professional manual treatment of patients. We discuss that a specific set of learning mechanisms might affect perceived self-efficacy of dental students, which in turn might reduce their affective component of pain perception.

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