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Oral Surg Oral Med Oral Pathol Oral Radiol. 2017 Jan;123(1):58-66. doi: 10.1016/j.oooo.2016.08.016. Epub 2016 Aug 27.

The impact of chronic orofacial pain on daily life: the vulnerable patient and disruptive pain.

Author information

1
Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
2
Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
3
In Partial Fulfillment of DMD Degree, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
4
Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel; Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel.
5
School of Dental Medicine, Rutgers University, Newark, NJ, USA.
6
Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel; Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel. Electronic address: galit@almoznino.com.

Abstract

OBJECTIVE:

To identify patient and pain characteristics associated with negative impacts on daily life among patients with chronic orofacial pain (COFP).

STUDY DESIGN:

Medical records of 200 COFP patients were analyzed.

RESULTS:

Diagnostic categories included temporomandibular disorders (85; 42.7%), headaches (47; 23.6%), neuropathic pain (37; 18.5%), trigeminal neuralgia (16; 8.0%), and painful posttraumatic trigeminal neuropathy (PTTN) (14; 7.0%). Of these, 47 (23.7%) had medical and 13 (6.5%) had psychiatric comorbidities and 71 (35.7%) experienced physical trauma. Seven (5%) had stopped working, and mean days absent from work was 3.3 ± 19.3. Patients were previously treated by 2.7 ± 1.4 caregivers. Mean scores on a 0-10 scale were as follows: pain (7.13 ± 2.3), sleep quality (6.6 ± 2.4), and quality of life (5.58 ± 3.1). PTTN patients were more likely to quit work (P = .009) and had more days absent from work (mean 24.3; P = .009). We identified patient and pain profiles that predict these poor outcomes. The "vulnerable patient" profile includes health and psychiatric comorbidities and trauma history, particularly PTTN. The "disruptive pain" profile includes severe, continuous, burning, electrical pain accompanied by systemic signs. These profiles intersect in a complex manner, creating a complex feedback loop.

CONCLUSIONS:

A multidisciplinary team approach is recommended to manage COFP patients, in order to improve treatment outcomes and avert more serious consequences.

PMID:
27727115
DOI:
10.1016/j.oooo.2016.08.016
[Indexed for MEDLINE]

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