Chronic orofacial pain is associated with psychological morbidity and negative personality changes: A comparison to the general population

Advancements in Understanding and Classifying Chronic Orofacial Pain: Key Insights from Biopsychosocial Models and International Classifications (ICHD-3, ICD-11, ICOP)

In exploring chronic orofacial pain (COFP), this review highlights its global impact on life quality and critiques current diagnostic systems, including the ICD-11, ICOP, and ICHD-3, for their limitations in addressing COFP's complexity. Firstly, this study outlines the global burden of chronic pain and the importance of distinguishing between different pain types for effective treatment. It then delves into the specific challenges of diagnosing COFP, emphasizing the need for a more nuanced approach that incorporates the biopsychosocial model. This review critically examines existing classification systems, highlighting their limitations in fully capturing COFP's multifaceted nature. It advocates for the integration of these systems with the DSM-5's Somatic Symptom Disorder code, proposing a unified, multidisciplinary diagnostic approach. This recommendation aims to improve chronic pain coding standardization and acknowledge the complex interplay of biological, psychological, and social factors in COFP. In conclusion, here, we highlight the need for a comprehensive, universally applicable classification system for COFP. Such a system would enable accurate diagnosis, streamline treatment strategies, and enhance communication among healthcare professionals. This advancement holds potential for significant contributions to research and patient care in this challenging field, offering a broader perspective for scientists across disciplines.

Oral Health-Related Quality of Life among Chinese Chronic Orofacial Pain Patients with Psychological Health Problems: A Moderated Mediation Model

Psychological therapies are important for comprehensive chronic orofacial pain (COFP) treatment. This study is to validate the effects of psychological factors on oral health-related quality of life (OHRQoL) among COFP patients in China. Pain catastrophizing, which is a subjective cognitive emotion used to manage the psychological aspects of pain among COFP patients, was examined in relation to COFP severity and OHRQoL. All 479 participants were recruited in Changsha, Hunan Province, China. Cronbach's alpha coefficients (0.868-0.960), composite reliability scores (0.924-0.969), and average variance extracted from each construct (0.555-0.753) all indicated a good model fit. Pearson's correlation analysis showed that age and education status have a positive correlation with COFP severity, pain catastrophizing, and anxiety. COFP severity was related to anxiety, depression, and COFP-OHRQoL. Pain catastrophizing was related to employment status. Anxiety and depression symptoms indirectly mediated the correlation between COFP severity and COFP-OHRQoL. As a second-stage moderator, pain catastrophizing moderated the mediating effects of anxiety symptoms and depression symptoms. Our findings suggest that anxiety, depression, and pain catastrophizing should be evaluated jointly to improve COFP-OHRQoL among COFP patients. This evidence will help therapists to comprehensively treat patients for the best treatment effect.

Anger and substance use in HIV-positive patients with chronic pain

Chronic pain increases the risk of substance use in people living with HIV (PLWH). Depression and anxiety have also been identified as risk factors for substance use among PLWH. Relatedly, other negative mood states, such as anger, may influence chronic pain among PLWH. The current cross-sectional study examined whether the distinct negative mood state of anger is associated with substance use among 187 PLWH who report chronic pain. Using negative binomial regression analyses, we found higher levels of anger were positively associated with alcohol use. Higher levels of anger were inversely associated with benzodiazepine use. No association was found between anger and marijuana use, and there were no significant interactions between anger and pain severity on substance use. Our findings suggest that anger is an independent risk factor for substance use among PLWH and chronic pain. Addressing anger may be useful when adapting behavioral therapies in the treatment of pain among PLWH.

Measuring anger in patients experiencing chronic pain - A systematic review

Anger is prevalent in chronic pain and has been associated with pain perception, disability, behavior and treatment outcome. Objectives were (1) to survey in the context of chronic pain the application (and omission) of validated anger self-report instruments, (2) to discuss the instruments found in the context of emotion theories and (3) to identify a possible instrument preference. A systematic search of textbooks and review articles was first performed on validated instruments designed to measure the cognitive, the motivational and the subjective feeling component of anger. Thereafter, a systematic review aimed at finding chronic pain studies from 2005 to 2019 reporting on these instruments. Textbooks and reviews listed 16 validated self-report anger measurement instruments. 28 papers applying four of these were identified and two new instruments were additionally detected. The State-Trait Anger Expression (STAXI) and its precursors were most commonly used. Studies on chronic low back pain patients prevailed. In conclusion, anger in chronic pain patients is reliably measurable at low cost with self-report tools. The STAXI-II qualifies best for this purpose based on its extensive validation history. The majority of instruments lack sufficient theoretical and psychometric adequacy. A more detailed exploration of the cognitive anger component in chronic pain patients in future research is recommended.

In quest of the longest-lasting and most annoying pain for patients and for dentists. Quantitative and qualitative characteristics of temporomandibular myofascial pain dysfunction syndrome – a questionnaire study

Background

Dysfunctions in the face, due to the psychological importance of the structures in the face and head, have long been a subject of interest for researchers exploring issues concerning health-related quality of life. The surprising results of previous clinical trials for myofascial pain dysfunction syndrome of the temporomandibular joints encouraged the present authors to plan a study focused on obtaining systematic knowledge of the issue.

Participants and procedure

The study included 26 patients of the Masticatory System Disorders Laboratory of the Dental Prosthetic Clinic at the Jagiellonian University Medical College diagnosed with the painful form of muscle-related functional masticatory organ disorders. The study was part of a larger research project. The data to be analysed for this article was obtained in the course of a single questionnaire survey conducted prior to the start of the treatment process.

Results

The results showed the quantitative characteristics of pain experiences in the clinical group, observed in the context of the circadian dynamics, psychophysical factors, and the location of pain, as well as their quality characteristics. The analyses showed negative covariances of the quality of life perceived by patients and the length of periods without pain, pain intensifying factors, and emotional image of pain. The strongest pain experienced by the patients negatively correlated with the quality of life related to the sphere of physical pain and mental distress, whereas the weakest pain correlated with the quality of life related to the social sphere. The lower quality of life occurred together with the frontal, zygomatic, mental, parotideomasseteric, and occipital region.

Conclusions

It is necessary to further analyse the issue on a larger sample in order to explain and clarify the obtained results.

The Association Between Psychological Factors and Orofacial Pain and Its Effect on Quality of Life: A Hospital Based Study

OBJECTIVE

To examine the hypothesis that psychological factors of psychological distress and perception of unhappiness in childhood are associated with self reported orofacial pain and to examine whether such patients have a poorer perception of their oral health related quality of life and if so then to what extent.

MATERIALS AND METHODS

A cross-sectional hospital based study was conducted in Hitkarini Dental College and Hospital, Jabalpur amongst 400 cases and 400 controls. Patients were included based on Locker and Slade's criteria. Patients were asked to complete 27 items Questionnaire which included the General Health Questionnaire to assess for psychological distress and Oral Health Impact Profile-14 for evaluating impact on quality of life. Bivariate and logistic regression analyses were performed to determine the degree of association between psychological factors, unhappy childhood and quality of life. P-value of less than 0.05 was considered statistically significant.

RESULTS

An increased propensity to report orofacial pain was seen for those individuals with higher levels of Psychological Distress and with perception of Unhappiness in Childhood. These individuals also reported with poorer perception of their oral health related Quality of Life.

CONCLUSION

The present study has shown relationship between Orofacial Pain, Quality of Life and Psychological Factors.

Experiences by patients and health professionals of a multidisciplinary intervention for long-term orofacial pain

The aim of the present study was to describe patients' and health professionals' experiences of a multidisciplinary stress-focused clinical evaluation with prolonged engagement as an intervention for patients with long-term orofacial pain. Data in the patient part of this study were collected by free-text questionnaires using open-ended questions. Data were collected by group interview in the part of the study concerning health professionals. All data were analyzed according to qualitative content analysis. Data from patients revealed three categories for the intervention, ie, "helpful for most and crucial for some", "being listened to, respected and validated", and "gives important coping strategies". The results showed that a vast majority of patients described themselves as having been helped by the intervention. Some patients reported that meeting with the orofacial pain consultant team was crucial to the future course of their lives. Most patients described still having residual pain and symptoms, and only a few described their pain as being fully remitted. However, because of the intervention, the patients reported being able to adopt more constructive coping strategies. They also described their perception of the pain as being different, in that it was not so frightening once they had been given a model with which to understand it. Data from the health professionals revealed similar categories. Concordance between the patients' and health professionals' experiences was striking. In their descriptions, the health professionals and patients underscored the same components as being effective, with understanding, respect, and validation being the most important. The multidisciplinary approach was highlighted as being key to success by both the patients and health professionals.

Talk of frustration in the narratives of people with chronic pain

OBJECTIVES

To improve understanding of the sources of frustration for people with chronic pain and consider the potential influence of frustration on the chronic pain experience and relationships with health professionals.

METHODS

Qualitative in-depth interviews with a diverse, maximum variation sample of 46 participants with chronic pain, 30 of whom talked about frustration. Analysis paid close attention to how people talked about their frustration as well as what they said.

RESULTS

Frustration is a multi-faceted emotion and its effects are cumulative. Sources of frustration include interference with everyday activities, the interruption of life goals and roles and the unpredictability of pain; here we focus on the frustrations associated with the invisibility of chronic pain and the perceived limitations of diagnosis and pain management (both related to the perceived legitimacy of the condition). Several of the participants who had lived with chronic pain for many years described overcoming, or managing, their frustrations.

DISCUSSION

If patients think that their pain is not being believed this is clearly a barrier to an effective consultation. Communication with chronic pain patients may improve if the frustration of living with an invisible, debilitating condition that is hard to diagnose and treat is explicitly (and perhaps repeatedly) acknowledged by the health professional.

Influences of adult-onset diabetes on orofacial pain and related health behaviors

OBJECTIVES

This study tested the hypothesis that persons with orofacial pain and comorbid adult-onset diabetes will experience greater functional and emotional impact than persons experiencing orofacial pain without diabetes.

METHODS

A random-digit dialing sampling procedure was used for a disproportionate probability sample of 10,341 persons who were screened for orofacial pain in the past 6 months and diabetes. This paper reports on 1,767 individuals reporting toothache pain and 877 reporting painful oral sores. A structured telephone interview assessed diabetes history, orofacial pain characteristics, oral health-care behaviors, and emotional and functional impacts of orofacial pain.

RESULTS

The 6-month point prevalence was 16.8 percent for toothache pain, 8.9 percent for painful oral sores, and 9.6 percent for adult-onset diabetes. Individuals with comorbid orofacial pain and adult-onset diabetes differed significantly on many of the pain characteristics and health behaviors compared with nondiabetic sufferers of orofacial pain. Diabetics were more likely than nondiabetics to have pain every day, to suffer negative emotions associated with pain, to experience disruption of daily activities and sleep, to make an emergency room visit for orofacial pain, and to report the current need for a pain-related health-care visit.

CONCLUSIONS

Although diabetes is well known to be associated with neuropathic pain, these results indicate that the experience of nociceptive pain is exacerbated by diabetes. Findings have significance for the subjective experience of oral pain, dental-care outcomes, and health-related quality of life associated with oral-health outcomes among individuals with diabetes.

Influence of pharmacologically-induced experimental anxiety on nociception and antinociception in rats

Animal studies reveal that diverse environmental stimuli that generate anxiety-like behaviors also induce antinociception; conversely, clinical data show that pain perception is reduced under anxiolysis. This study was conducted to investigate the influence of pharmacologically induced-anxiety on nociception and antinociception. Experimental anxiety levels were measured using the rat burying behavior test. Diazepam (0, 0.5, 1.0 and 2.0 mg/kg, i.p.) or yohimbine (0, 0.5 and 1.0 mg/kg, i.p.) were used as anxiolytic or anxiogenic drugs, respectively. To evaluate the influence of different experimental anxiety levels on nociception, the pain-induced functional impairment in the rat (PIFIR model) was used. Nociception was induced by an intra-articular injection of 15% uric acid into the knee joint of the right hind limb. Diazepam or yohimbine were administered 15 min before uric acid and the ability of the rat to use the injured hind limb was recorded. To analyze the influence of different levels of anxiety on the antinociceptive effects produced by acetylsalicylic acid (0, 31, 100 and 310 mg/kg, p.o.); this analgesic was administered 3.5 h after uric acid. Fifteen min before diazepam (2.0 mg/kg) or yohimbine (1.0 mg/kg) were administered. We found that, in the burying behavior test, diazepam and yohimbine produced a dose-dependent decrease or augment in the cumulative time of burying, effects denoting reduced or increased experimental anxiety, respectively. Diazepam or yohimbine, administered alone, was unable to produce nociception. The results showed an influence of anxiety on nociception since a decreased (by diazepam) or increased (by yohimbine) experimental anxiety prevented nociception. Control experiments showed that acetylsalicylic acid did not modify experimental anxiety in the burying behavior test, but effectively reversed the nociception induced by uric acid (15%) in the PIFIR model. Such antinociceptive effect was unmodified by the anxiolytic or anxiogenic actions of diazepam or yohimbine. Data are discussed on the bases of clinical- and animal-studies revealing interactions between anxiety and nociception.

Analysis of the acute postoperative pain experience following oral surgery: identification of 'unaffected', 'disabled' and 'depressed, anxious and disabled' patient clusters

BACKGROUND

Pain is defined as both a sensory and an emotional experience. Acute postoperative tooth extraction pain is assessed and treated as a physiological (sensory) pain while chronic pain is a biopsychosocial problem. The purpose of this study was to assess whether psychological and social changes occur in the acute pain state.

METHODS

A biopsychosocial pain questionnaire was completed by 438 subjects (165 males, 273 females) with acute postoperative pain at 24 hours following the surgical extraction of teeth and compared with 273 subjects (78 males, 195 females) with chronic orofacial pain. Statistical methods used a k-means cluster analysis.

RESULTS

Three clusters were identified in the acute pain group: 'unaffected', 'disabled' and 'depressed, anxious and disabled'. Psychosocial effects showed 24.8 per cent feeling 'distress/suffering' and 15.1 per cent 'sad and depressed'. Females reported higher pain intensity and more distress, depression and inadequate medication for pain relief (p < 0.001). Distress and depression were associated with higher pain intensity. The developed questionnaire had tested reliability (test-retest r = 0.89) and estimated validity.

CONCLUSION

Cluster analysis showed constituent groups with a range of psychosocial effects in acute postoperative dental extraction pain and is associated with an increase in pain intensity.