JMIR Publications

ABSTRACT

Background:

FMRI studies show that medical doctors suppress the pain matrix when they view painful actions executed on others. But how do doctors perceive pain from a self-perspective?

Objective:

We hypothesize that virtual dental treatment from a self-perspective may induce brain activity in pain related areas in controls while this is less the case for dental students. We expect that dental students learn to control the motoric aspects of pain during their education because it is a prerequisite for manual treatment.

Methods:

In this fMRI study, neural correlates of pain perception from a self-perspective in a sample of 20 dental students and 20 age matched controls were investigated trough classic general linear model analysis and in house classification methods. All subjects viewed video clips presenting a dental treatment from the first‐person perspective. Dental students and naïve controls exhibited similar anxiety levels for invasive stimuli.

Results:

Invasive dentistry scenes evoked less affective component of pain in dental students compared to naïve controls. Reduced affective pain perception went along with suppressed brain activity in pain matrix areas including insula, anterior cingulate cortex and basal ganglia. Furthermore, a substantial reduction of brain activity was observed in motor related areas in particular the supplementary motor area, premotor cortex and basal ganglia (p<0.001, k=156). Within this context a classifier analysis based on neural activity in the nucleus lentiformis (p<0.0005 with k=125) could identify dental students and controls on the individual subject level in 85 percent of the cases (sensitivity = 90.0%; specificity = 80.0%).

Conclusions:

We speculate that dentistry students learn to control motoric aspects of pain during their education because it is a prerequisite for professional manual treatment of patients. We discuss that a specific set of learning mechanism might affect perceived self-efficacy of dental students, which in turn might reduce their affective component of pain perception.