Utility of a Salivary Biosensor for Objective Assessment of Surgery-Related Stress

Abstract

PURPOSE To evaluate the clinical utility of a salivary alpha-amylase (sAA) biosensor for assessing oral surgery-related stress responses and the differential effect of the personality trait of pain catastrophizing. PATIENTS AND METHODS We conducted a prospective, cohort study of 76 healthy subjects who underwent elective removal of their third molars. Along with subjects’ self-reports of anxiety and pain, biosensor-facilitated measurements of sAA levels were obtained at multiple time points during the preoperative consult, surgery, and post-surgical follow-up visits. Additionally, subjects completed the Pain Catastrophizing Scale at baseline. Mixed-effect regression models examined change in sAA and self-report ratings within and across visits, and the contribution of pain catastrophizing. RESULTS sAA levels were lower during surgery and post-surgical follow-up compared to the consult visit (p < .01). sAA decreased during the surgery visit (p < .05), and did not change during the consult or follow-up visits. Individuals who reported greater helplessness responses to pain manifested higher sAA levels during the surgery visit (p < .05). Self-reported anxiety ratings were highest during the surgery visit, and pain ratings were highest during the follow-up visit. CONCLUSION sAA did not show predicted elevations during the surgery visit compared to the consult and post-surgical follow-up visits, or increases during the surgery visit. However, individuals who reported responding to pain with helplessness had larger sAA levels in anticipation of surgery, providing proof of concept for the value of point-of-care assessments of surgery-induced stresses and the differential effect of personality traits.

Performance Evaluation of a Salivary Amylase Biosensor for Stress Assessment in Military Field Research

“…It has been used in a number of studies to provide close to real-time measurement of salivary amylase levels as a biomarker for stress from academic examination (18), a trier social stress test (23), a flight task (24), a simulated space mission (25), and surgeries (26,27).…”

Reliability of Potential Pain Biomarkers in the Saliva of Healthy Subjects: Inter-Individual Differences and Intersession Variability

“…The most important putative biomarkers already described in saliva related to pain are cortisol [10], salivary alpha-amylase (sAA) [11], secretory immunoglobulin A (sIgA) [12], testosterone [13], and soluble tumor necrosis factor-α receptor II (sTNFαRII) [14]. Since 1987, cortisol has been by far the most often used biomarker for acute pain [15].…”

“…sAA is one [11] even though it undergoes a diurnal variation [25–27], and there are several factors that might influence the daily cycle, it still could be helpful for pain assessment [28]. …”

Salivary Alpha Amylase, Dental Anxiety, and Extraction Pain: A Pilot Study

“…Those patients had a significant and progressive increase of sAA concentration during orthodontic treatment, but this increase was likewise not linearly correlated with pain intensity. Robles et al 25 found that sAA levels were lower prior to extraction than compared to consult and followup visits. Robles et al 25 hypothesized that both the anticipation of extraction and the effort expended to arrive at the clinic (ie, rushing to be on time) could have led to an increase in autonomic activity.…”

“…Robles et al 25 found that sAA levels were lower prior to extraction than compared to consult and followup visits. Robles et al 25 hypothesized that both the anticipation of extraction and the effort expended to arrive at the clinic (ie, rushing to be on time) could have led to an increase in autonomic activity. It was thought that this increase would then decrease over time as the patients arrived at the clinic and were able to acclimate to the setting.…”