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Erdogan O, Ramsey A, Uyanik JM, Gibbs JL, Burns LE. Outcomes of referrals from endodontic to orofacial pain specialists: A retrospective cohort study. Clin Exp Dent Res 2021; 8:457-463. [PMID: 34623771 PMCID: PMC8874062 DOI: 10.1002/cre2.497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/11/2021] [Accepted: 08/25/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Diagnosis and treatment of non-odontogenic pain is challenging for endodontists. The purpose of the study was to investigate the outcomes of referrals to orofacial pain specialists made for patients with suspected non-odontogenic pain, after evaluation and/or treatment by an endodontist. MATERIALS AND METHODS A retrospective review of dental records was conducted for 60 patients referred from a postgraduate endodontic clinic to an orofacial pain clinic. Patient demographics, pain history, endodontic, and orofacial pain diagnoses were collected. Number of visits, length of treatment, and treatments prescribed were recorded. For analysis of outcomes, data pertinent to resolution/persistence of symptoms and patient compliance were analyzed. RESULTS Thirty-five patients were included in the study. The most frequent pulpal and periapical diagnoses were previously treated (62%) and symptomatic apical periodontitis (72%), respectively. The most common orofacial pain diagnosis was temporomandibular disorder. The average time spent to diagnose and treat the pain was 17 months. Pain reduction varied and was documented for 51% of patients. Indications of non-compliance with orofacial pain appointments and treatments were documented for 66% of patients. CONCLUSIONS Non-odontogenic pain diagnosis and treatment are challenging. Patients may have an increased predilection for developing persistent pain after endodontic treatment and/or have an undiagnosed, chronic orofacial pain condition as a true source of their chief complaint. It may be helpful for endodontists to set expectations of typical treatment times/plans when referring patients for evaluation and treatment of non-odontogenic pain.
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Affiliation(s)
- Ozge Erdogan
- Department of Endodontics, College of DentistryNew York UniversityNew YorkNew YorkUSA
- Division of Endodontics in Restorative Dentistry and Biomaterials SciencesHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Austin Ramsey
- Department of Endodontics, College of DentistryNew York UniversityNew YorkNew YorkUSA
| | - James M. Uyanik
- Department of Oral and Maxillofacial Pathology, Radiology and MedicineCollege of Dentistry, New York UniversityNew YorkNew YorkUSA
| | - Jennifer L. Gibbs
- Division of Endodontics in Restorative Dentistry and Biomaterials SciencesHarvard School of Dental MedicineBostonMassachusettsUSA
| | - Lorel E. Burns
- Department of Endodontics, College of DentistryNew York UniversityNew YorkNew YorkUSA
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Jafree DJ, Zakrzewska JM, Bhatia S, Venda Nova C. Accuracy of the painDETECT screening questionnaire for detection of neuropathic components in hospital-based patients with orofacial pain: a prospective cohort study. J Headache Pain 2018; 19:103. [PMID: 30400770 PMCID: PMC6755558 DOI: 10.1186/s10194-018-0932-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/16/2018] [Indexed: 01/03/2023] Open
Abstract
Background Better tools are required for the earlier identification and management of orofacial pain with different aetiologies. The painDETECT questionnaire is a patient-completed screening tool with utility for identification of neuropathic pain in a range of contexts. 254 patients, referred from primary care for management of orofacial pain and attending a secondary care centre, were prospectively recruited, and completed the painDETECT prior to consultation. The aim of this study was to determine the accuracy of the painDETECT to detect neuropathic components of orofacial pain, when compared to a reference standard of clinical diagnosis by experienced physicians, in a cohort of hospital-based patients. Results For the 251 patients included in the analysis, the painDETECT had a modest ability to detect neuropathic components of orofacial pain (AUROC, 0.63; 95% CI, 0.58–0.70; p = 0.001). Patients with orofacial pain diagnoses associated with neuropathic components had higher painDETECT scores than those with non-neuropathic components. However, the painDETECT was weaker at distinguishing patients with mixed pain types, and multiple diagnoses were associated with poor accuracy of the painDETECT. Conclusion In secondary care settings, the painDETECT performed modestly at identifying neuropathic components, and underestimates the complexity of orofacial pain in its mixed presentations and with multiple diagnoses. Prior to clinical applications or research use, the painDETECT and other generic screening tools must be adapted and revalidated for orofacial pain patients, and separately in primary care, where orofacial pain is considerably less common. Electronic supplementary material The online version of this article (10.1186/s10194-018-0932-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniyal J Jafree
- Faculty of Medical Sciences, University College London, London, UK.
| | | | - Saumya Bhatia
- Eastman Dental Institute, UCLH NHS Foundation Trust, London, UK
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Abstract
The diagnosis and management of orofacial pain may be challenging due to complex histories, pathophysiology and associated psychosocial co-morbidities such as depression and anxiety. Neuropathic facial pain conditions such as burning mouth syndrome (BMS), persistent idiopathic facial pain (PIFP), atypical odontalgia (AO) and trigeminal neuralgia (TN) require early recognition by primary care clinicians and referral to secondary care. Acute pain-related temporomandibular disorder (TMD) may be managed in the primary care setting, with identification of those at risk of developing chronic TMD receiving an early referral to secondary care. Adopting a biopsychosocial approach, consisting of physical therapies, pharmacotherapy and psychological support can lead to effective management and may limit the negative impact of facial pain upon quality of life and daily functioning.
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Breckons M, Bissett SM, Exley C, Araujo-Soares V, Durham J. Care Pathways in Persistent Orofacial Pain: Qualitative Evidence from the DEEP Study. JDR Clin Trans Res 2016; 2:48-57. [PMID: 28879244 DOI: 10.1177/2380084416679648] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.
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Affiliation(s)
- M Breckons
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - S M Bissett
- Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
| | - C Exley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - V Araujo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - J Durham
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Centre for Oral Health Research, School of Dental Sciences, Newcastle University, UK
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Durham J, Shen J, Breckons M, Steele JG, Araujo-Soares V, Exley C, Vale L. Healthcare Cost and Impact of Persistent Orofacial Pain: The DEEP Study Cohort. J Dent Res 2016; 95:1147-54. [PMID: 27154734 DOI: 10.1177/0022034516648088] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Few data are available on the healthcare costs of those suffering from persistent orofacial pain (POFP). This cohort and cost analysis study examined the direct costs of POFP from the perspective of the healthcare provider (specifically, the UK National Health Service) in 2012 pounds sterling and sought to identify whether dichotomized (high, IIb to IV; low, 0 to IIa) graded chronic pain scale (GCPS) status is predictive of the total cost of healthcare over the last 6 mo. The healthcare utilization data of 198 patients with POFP were collected using a structured interview and a validated "use of services and productivity" questionnaire. Unit costs were used with these utilization data to calculate direct healthcare costs in 3 categories: consultation, medication, and appliances and interventions. Consultation costs were a significant proportion of cumulative healthcare cost (P < 0.001). Dichotomized GCPS status was predictive of increased healthcare cost over the last 6 mo, accounting for an average increase of £366 (95% confidence interval, 135 to 598; P < 0.01) when moving from a low GCPS status to a high GCPS status. Given the predictive capability of dichotomized GCPS status and the success of stratified models of care for other persistent pain conditions, dichotomized GCPS status may offer an opportunity to help determine stratification of care for patients with POFP.
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Affiliation(s)
- J Durham
- Centre for Oral Health Research and Institute of Health and Society, School of Dental Sciences, Newcastle University, Newcastle, UK, and Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J Shen
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - M Breckons
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
| | - J G Steele
- Centre for Oral Health Research and Institute of Health and Society, School of Dental Sciences, Newcastle University, Newcastle, UK, and Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust Institute of Health and Society, Newcastle upon Tyne, UK
| | | | - C Exley
- Institute of Health and Society, Newcastle upon Tyne, UK
| | - L Vale
- Health Economics Group, Institute of Health and Society, Newcastle upon Tyne, UK
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Smiljic S, Savic S, Stevanovic J, Kostic M. Prevalence and characteristics of orofacial pain in university students. J Oral Sci 2016; 58:7-13. [PMID: 27021534 DOI: 10.2334/josnusd.58.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sonja Smiljic
- Department of Physiology, Medical Faculty, University of Pristina
| | - Sladjana Savic
- Department of Histology, Medical Faculty, University of Pristina
| | | | - Mirjana Kostic
- Department of Public Health, Medical Faculty, University of Pristina
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Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. WITHDRAWN: Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev 2015; 2015:CD008456. [PMID: 26678041 PMCID: PMC10644005 DOI: 10.1002/14651858.cd008456.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Cochrane Oral Health Group withdrew this review as of Issue 12, 2015. The review is out of date and does not meet current Cochrane methodological standards. It will be superseded by a new Cochrane review on psychological interventions for managing temporomandibular disorders and the update of Zakrzewska JM, Forssell H, Glenny AM. Interventions for the treatment of burning mouth syndrome. Cochrane Database of Systematic Reviews 2005, Issue 1. DOI: 10.1002/14651858.CD002779.pub2. The editorial group responsible for this previously published document have withdrawn it from publication.
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Affiliation(s)
- Vishal R Aggarwal
- The University of ManchesterCentre for Clinical and Cognitive Neurosciences, Institute of Brain Behaviour and Mental HealthOxford RoadManchesterUKM13 9PL
| | - Karina Lovell
- The University of ManchesterSchool of Nursing, Midwifery and Social WorkRoom 6.322a, Jean McFarlane BuildingUniversity Place, Oxford RoadManchesterManchesterUKM13 9PL
| | - Sarah Peters
- The University of ManchesterSchool of Psychological SciencesRoom 1.25, Coupland Building 1Oxford RoadManchesterUKM13 9PL
| | - Hanieh Javidi
- School of Dentistry, The University of ManchesterOral Health UnitCoupland 3 BuildingOxford RoadManchesterUKM13 9PL
| | - Amy Joughin
- School of Dentistry, The University of ManchesterOral Health UnitCoupland 3 BuildingOxford RoadManchesterUKM13 9PL
| | - Joanna Goldthorpe
- School of Dentistry, The University of ManchesterOral Health UnitCoupland 3 BuildingOxford RoadManchesterUKM13 9PL
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Ceusters W, Michelotti A, Raphael KG, Durham J, Ohrbach R. Perspectives on next steps in classification of oro-facial pain - part 1: role of ontology. J Oral Rehabil 2015. [PMID: 26212927 DOI: 10.1111/joor.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to review existing principles of oro-facial pain classifications and to specify design recommendations for a new system that would reflect recent insights in biomedical classification systems, terminologies and ontologies. The study was initiated by a symposium organised by the International RDC/TMD Consortium Network in March 2013, to which the present authors contributed. The following areas are addressed: problems with current classification approaches, status of the ontological basis of pain disorders, insufficient diagnostic aids and biomarkers for pain disorders, exploratory nature of current pain terminology and classification systems, and problems with prevailing classification methods from an ontological perspective. Four recommendations for addressing these problems are as follows: (i) develop a hypothesis-driven classification structure built on principles that ensure to our best understanding an accurate description of the relations among all entities involved in oro-facial pain disorders; (ii) take into account the physiology and phenomenology of oro-facial pain disorders to adequately represent both domains including psychosocial entities in a classification system; (iii) plan at the beginning for field-testing at strategic development stages; and (iv) consider how the classification system will be implemented. Implications in relation to the specific domains of psychosocial factors and biomarkers for inclusion into an oro-facial pain classification system are described in two separate papers.
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Affiliation(s)
| | | | - K G Raphael
- New York University College of Dentistry, New York, NY, USA
| | - J Durham
- Newcastle University, Newcastle, UK
| | - R Ohrbach
- University at Buffalo, Buffalo, NY, USA
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Retrospective examination of the healthcare 'journey' of chronic orofacial pain patients referred to oral and maxillofacial surgery. Br Dent J 2014; 214:E12. [PMID: 23470414 DOI: 10.1038/sj.bdj.2013.221] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To gain a deeper understanding of the clinical journey taken by orofacial pain patients from initial presentation in primary care to treatment by oral and maxillofacial surgery. DESIGN Retrospective audit. SAMPLE AND METHODS Data were collected from 101 consecutive patients suffering from chronic orofacial pain, attending oral and maxillofacial surgery clinics between 2009 and 2010. Once the patients were identified, information was drawn from their hospital records and referral letters, and a predesigned proforma was completed by a single examiner (EVB). Basic descriptive statistics and non-parametric inferential statistical techniques (Krushal-Wallis) were used to analyse the data. DATA AND DISCUSSION: Six definitive orofacial pain conditions were represented in the data set, 75% of which were temporomandibular disorders (TMD). Individuals within our study were treated in nine different hospital settings and were referred to 15 distinct specialties. The mean number of consultations received by the patients in our study across all care settings is seven (SD 5). The mean number of specialities that the subjects were assessed by was three (SD 1). The sample set had a total of 341 treatment attempts to manage their chronic orofacial pain conditions, of which only 83 (24%) of all the treatments attempted yielded a successful outcome. CONCLUSION Improved education and remuneration for primary care practitioners as well as clear care pathways for patients with chronic orofacial pain should be established to reduce multiple re-referrals and improve efficiency of care. The creation of specialist regional centres for chronic orofacial pain may be considered to manage severe cases and drive evidence-based practice.
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Developing Effective and Efficient care pathways in chronic Pain: DEEP study protocol. BMC Oral Health 2014; 14:6. [PMID: 24447722 PMCID: PMC3909482 DOI: 10.1186/1472-6831-14-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/13/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pain affecting the face or mouth and lasting longer than three months ("chronic orofacial pain", COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently. METHODS/DESIGN The study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary. DISCUSSION The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.
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Abstract
OBJECTIVE Malignant tumours of the nasal cavity and paranasal sinuses are rare and late presentation of a maxillary sinus tumour is common due to the vague nature of the symptoms which can delay diagnosis. METHODS We report a female with a maxillary sinus tumour who was initially diagnosed with chronic idiopathic facial pain (CIFP) and sinusitis, which subsequently led to a delay in diagnosis and treatment of her tumour. RESULTS There was no clinical extra- or intra-oral pathology, however, she had varying clinical presentations of facial pain, anosmia, loss of gustatory function, and infra-orbital nerve paraesthesia. CT and MRI scans confirmed obliteration of the left maxillary sinus by a solid mass involving ethmoid and sphenoid sinuses and some cranial nerves. Biopsy confirmed a poorly differentiated carcinoma of the ethmoid and sphenoid sinuses and invasion of the cavernous sinus. CONCLUSION A morbid, but hidden tumour was left undiagnosed due to the unusual presentation of the patient's symptoms. It is essential that all patients are managed holistically and thorough historical, clinical and radiographic examination and appropriate investigations are carried out to prevent unnecessary and potentially time-wasting treatment.
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Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev 2011:CD008456. [PMID: 22071849 DOI: 10.1002/14651858.cd008456.pub2] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Psychosocial factors have a role in the onset of chronic orofacial pain. However, current management involves invasive therapies like occlusal adjustments and splints which lack an evidence base. OBJECTIVES To determine the efficacy of non-pharmacologic psychosocial interventions for chronic orofacial pain. SEARCH METHODS The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 25 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 25 October 2010), EMBASE via OVID (1980 to 25 October 2010) and PsycINFO via OVID (1950 to 25 October 2010). There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials which included non-pharmacological psychosocial interventions for adults with chronic orofacial pain compared with any other form of treatment (e.g. usual care like intraoral splints, pharmacological treatment and/or physiotherapy). DATA COLLECTION AND ANALYSIS Data were independently extracted in duplicate. Trial authors were contacted for details of randomisation and loss to follow-up, and also to provide means and standard deviations for outcome measures where these were not available. Risk of bias was assessed and disagreements between review authors were discussed and another review author involved where necessary. MAIN RESULTS Seventeen trials were eligible for inclusion into the review. Psychosocial interventions improved long-term pain intensity (standardised mean difference (SMD) -0.34, 95% confidence interval (CI) -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). However, the risk of bias was high for almost all studies. A subgroup analysis revealed that cognitive behavioural therapy (CBT) either alone or in combination with biofeedback improved long-term pain intensity, activity interference and depression. However the studies pooled had high risk of bias and were few in number. The pooled trials were all related to temporomandibular disorder (TMD). AUTHORS' CONCLUSIONS There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain. Although significant effects were observed for outcome measures where pooling was possible, the studies were few in number and had high risk of bias. However, given the non-invasive nature of such interventions they should be used in preference to other invasive and irreversible treatments which also have limited or no efficacy. Further high quality trials are needed to explore the effects of psychosocial interventions on chronic orofacial pain.
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Affiliation(s)
- Vishal R Aggarwal
- Oral Health Unit, School of Dentistry, The University of Manchester, Manchester, UK.
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Aggarwal VR, Joughin A, Zakrzewska JM, Crawford FJ, Tickle M. Dentists’ and Specialists’ Knowledge of Chronic Orofacial Pain: Results from a Continuing Professional Development Survey. ACTA ACUST UNITED AC 2011; 18:41-4. [DOI: 10.1308/135576111794065838] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aim To explore the knowledge of chronic orofacial pain within general dental practitioners (GDPs) and dental specialists. Methods Following a recent national survey of GDPs and specialists on the diagnosis of facial pain, all those who responded were asked to answer four multiple-choice questions on chronic orofacial pain as part of a continuing professional development exercise. The questions were formulated using a review of the literature and consultation with a facial pain expert and were administered by post. Results Of the 380 subjects who completed the original survey, 212 (56%) returned completed multiple-choice questionnaires. Specialists correctly answered significantly more questions than GDPs ( P<0.001). The majority of specialists—49/83 (59%)—obtained a score of three or more, compared to 39/129 (30%) GDPs. This was due to variation in answering one question. Significantly more specialists—50 (60%)—correctly selected trigeminal neuralgia (TN) as a condition that is not associated with COFP, whereas only 41 (32%) GDPs chose this answer. Both specialists and GDPs grossly underestimated the prevalence of COFP in secondary care clinics. Conclusions The results suggest that specialists and GDPs may have sufficient knowledge to make an appropriate diagnosis of COFP, but they also highlight the knowledge gaps and perhaps the need for more extensive inclusion of COFP in the dental undergraduate curriculum.
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Affiliation(s)
| | | | - Joanna M Zakrzewska
- Facial Pain Lead. Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, London, UK
| | - Fiona J Crawford
- Oral Health Unit, School of Dentistry, University of Manchester, Manchester, UK
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Aggarwal VR. Unexplained toothache: an evidence-based approach to diagnosis and management. ACTA ACUST UNITED AC 2010; 17:29-32. [PMID: 20067688 DOI: 10.1308/135576110790307645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This 'in my opinion' paper uses two case studies to highlight the importance of making an early diagnosis of unexplained orofacial pain. Patients with this condition can present with symptoms that can easily be confused with more common dental pain that is related to an organic pathology. An incorrect diagnosis can lead to invasive and irreversible treatment using advanced surgical or restorative techniques that are not evidence-based. Current evidence supports the use of non-invasive techniques such as behavioural interventions; for example, cognitive behaviour therapy. It is therefore imperative that patients with this condition are recognised early in primary care so that management is appropriate from the outset. This will prevent unnecessary invasive intervention, protecting the patient from harm and the practitioner from litigation.
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Affiliation(s)
- Vishal R Aggarwal
- Oral Health Unit, School of Dentistry, University of Manchester, UK.
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Top ten downloaded BDJ papers, January-August 2008. Br Dent J 2008. [DOI: 10.1038/sj.bdj.2008.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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