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Children prenatally exposed to cocaine may be at elevated risk for adjustment problems in early development because of greater reactivity and reduced regulation during challenging tasks. Few studies have examined whether cocaine-exposed children show such difficulties during the preschool years, a period marked by increased social and cognitive demands and by rapid changes in reactivity and regulation. The authors addressed this question by examining frustration reactivity and regulation of behavior during a problem-solving task in cocaine-exposed and-unexposed preschoolers. Participants were 174 4.5-year-olds (M age = 4.55 years, SD = 0.09). Frustration reactivity was measured as latency to show frustration and number of disruptive behaviors, whereas regulation was measured as latency to approach and attempt the problem-solving task and number of problem-solving behaviors. Results indicated that cocaine-exposed children took longer to attempt the problem-solving task but that cocaine-exposed boys showed the most difficulties: They were quicker to express frustration and were more disruptive. Effect sizes were relatively small, suggesting both resilience and vulnerabilities.

A survey of 270 University of Washington permanent employees who were potential candidates for teaching clinics, found dental anxiety prevalent, correlating with poorer perceived dental health, longer intervals between dental appointments, higher frequency of past fear behaviors, more physical symptoms during last dental injection, and more symptoms of anxiety and depression. Implications for recognizing and managing fearful patients are discussed. (Author/MSE)

An experiment was conducted to determine whether providing children with information about the time remaining in each of 9 cold pressor trials would modify their pain reports. The study design included an experimental group and 2 control groups. The experimental group was given visual information about time remaining in each cold pressor trial using cartoon images presented on a computer screen. Control groups viewed either no images or randomly presented images. Temporal information reduced children's self-reported pain during short (10 to 15 s) duration cold pressor trials, but did not increase the number of trials completed. This study suggests that providing time-remaining information during brief clinical procedures may decrease children's discomfort.

Many children do not receive adequate local anesthesia to prevent pain during dental procedures, according to a study of 361 children treated by 17 pediatric dental practices. Of the 17 dentists, 14 had at least one patient who was in pain during the procedure.

This paper describes CARL (Computer Assisted Relaxation Learning), a computerized, exposure-based therapy program for the treatment of dental injection fear. The CARL program operates primarily in two different modes; in vitro, which presents a video-taped exposure hierarchy, and in vivo, which presents scripts for a dentist or hygienist to use while working with a subject. Two additional modes are used to train subjects to use the program and to administer behavioral assessment tests. The program contains five different modules, which function to register a subject, train subjects to use physical and cognitive relaxation techniques, deliver an exposure hierarchy, question subjects about the helpfulness of each of the therapy components, and test for memory effects of anxiolytic medication. Nine subjects have completed the CARL therapy program and 1-yr follow-up as participants in a placebo-controlled clinical trial examining the effects of alprazolam on exposure therapy for dental injection phobia. All nine subjects were able to receive two dental injections, and all reduced their general fear of dental injections. Initial results therefore indicate that the CARL program successfully reduces dental injection fear.

University of Washington students and staff revealed four fears concerning dental injections in a 1995 survey. The fear of pain was greatest for 18.9% of the respondents, injury for 15.1%, transmission of disease for 10.6%, and, to a much lesser degree, the anesthetic itself for 3.4%. Some 45% of those with anxiety above the average considered their dental health poor or fair, compared to 9.2% of those with anxiety below the average. Fewer than 5% reported cancelling, avoiding or not showing up for appointments because of needle fear. Dentists should identify and discuss these fears with patients in order to alleviate them.

Objective: The medical literature suggests that alcoholics may present greater challenges to achieving clinical pain control than nonalcoholics. This study was undertaken to test the hypotheses that: (1) significant differences exist between alcoholics and nonalcoholics on detection and pain thresholds during electric tooth stimulation; (2) group differences exist in the depth and time course of pulpal anesthesia; and (3) responses to tooth stimulation are associated with severity of alcoholism and/or other psychological factors. Method: Male alcoholics (n = 22) in aftercare treatment (mean length of sobriety = 113 days) and age-matched nonalcoholics (n = 22) received 1.0 ml of 3% mepivicaine at the apex of a maxillary lateral incisor and saline placebo at the apex of the contralateral incisor. Results: At baseline no group differences were found on sensory thresholds. During drug intervention significant drug and time effects for both detection threshold (p [is less than] .0001) and pain threshold (p [is less than] .0001) were found, but group differences and interactive effects were not significant. By exploratory regression analysis of alcoholic subjects, history of depression/unhappiness was significantly associated with shallower pulpal anesthesia, whereas high need for control/low actual control and frequency of treatment for detoxification were associated with deeper anesthesia. Conclusions: Our findings suggest alcoholics in recovery are not at increased risk for inadequate pain control with local anesthesia. (J. Stud. Alcohol 58: 291-296, 1997), Twenty-two recovering alcoholics, with a mean length of sobriety of 113 days, were not significantly different from a population of 22 nonalcoholics in their sensitivity to the pain-controlling effects of the local anesthesia mepivicaine, according to a dental study at the University of Washington. Prior pain management research in clinical settings suggested that alcoholics were less responsive to anesthesia and pain-controlling drugs than nonalcoholics. The study also found that psychological factors such as depression did affect alcoholics' level of response to local anesthesia., The medical literature suggests that a history of alcohol or nonalcohol drug abuse may predispose patients to achieve less effect from pharmacological methods for general anesthetics/pain control (Couderc et al., [...]

The authors presented a model that extrapolates the biological consequences of drug administration to account for acute and chronic tolerance. Drug-induced changes of regulated parameters provide detectable perturbations to which the brain responds. With experience, these centrally mediated responses are learned and can be activated in the absence of the drug-induced perturbation. Although neural responses following drug administration are often obscured, the model shows how these responses may be identified and provides a reinterpretation of drug conditioning paradigms. The authors made comparisons between the present empirical model of drug administration and existing theories of drug tolerance. The authors also presented a unified framework for understanding the consequences of repeated drug use and made specific predictions as to the relationships among acute and chronic tolerance, drug sensitization, and individual differences in vulnerability to drug addiction.