Systematic review of population-based epidemiological studies of oro-facial pain

OBJECTIVES

To conduct a systematic review of epidemiological literature in order to determine the prevalence and associated risk factors of oro-facial pain.

DATA

Population based observational studies (cohorts, cross-sectional and case-control studies) of oro-facial pain, published in the English language, prior to 1999 were included.

SOURCES

Electronic databases (Medline, Embase, Cinahl, BIDS and Health CD) were searched. Reference lists of relevant articles were examined, and the journals "Pain" and "Community Dentistry and Oral Epidemiology" were handsearched for the years 1994-1998.

RESULTS

The results of the search strategy were screened for relevance. A standardised checklist was used to assess the methodological quality of each study by two reviewers before an attempt was made to summarise the results. The median quality score was 70% of the maximum attainable score. Due to methodological issues, it was not possible to pool the data on the prevalence of oro-facial pain. Age, gender and psychological factors were found to be associated with OFP, however there was not enough information on other factors such as local mechanical and co-morbidities to draw any reliable conclusions. None of the factors fully fulfilled criteria for causality.

CONCLUSIONS

There is a need for good quality epidemiological studies of oro-facial pain in the general population. To enable comprehensive examination of the aetiology of oro-facial pain, it is necessary to address a broad range of factors including demography and life-style, local mechanical factors, medical history and psychological factors. Future studies should recruit adequately sized samples for precise determination of the prevalence and detection of important associated factors. Data on potential confounders and effect modifiers should also be collected and adjusted for in the statistical analysis.

The role of catastrophizing in the pain and depression of women with fibromyalgia syndrome

OBJECTIVE

Although 2 recent studies have found associations between catastrophizing and poor medical outcomes in patients with fibromyalgia syndrome (FMS), neither assessed these findings in comparison with a similar group of patients with chronic pain. Our study examined the complex relationships between depression, catastrophizing, and the multidimensional aspects of pain in women with FMS and compared these relationships with those in women with rheumatoid arthritis (RA).

METHODS

Sixty-four FMS patients and 30 RA patients completed the Coping Strategies Questionnaire (CSQ), the Beck Depression Inventory II (BDI-II), and the McGill Pain Questionnaire.

RESULTS

Compared with subjects with RA, FMS subjects scored significantly higher on the catastrophizing subscale of the CSQ. FMS patients also earned higher scores on overall depression and on the cognitive subscale of the BDI-II. Furthermore, the relationship between catastrophizing and depression was significant in the FMS group only. Regression analyses revealed that in FMS, catastrophizing as a measure of coping predicted patients' perception of pain better than demographic variables such as age, duration of illness, and education.

CONCLUSION

Cognitive factors, such as catastrophizing and depressive self-statements, have a more pronounced role in the self-reported pain of patients with FMS than in patients with RA. Clinically, this indicates that treating pain and depression in FMS by adding cognitive therapy and coping skills components to a comprehensive treatment program may improve the outcomes obtained with pharmacologic interventions.

Myofascial face pain: seasonal variability in pain intensity and demoralization

Seasonal variability has been detected in a variety of illnesses. The purpose of this study is to examine seasonal variability in pain intensity, demoralization and range of mandibular motion among patients suffering from myofascial face pain. Pain and demoralization for cases (n = 140) and demoralization for controls (n = 133) were measured in each of 10 monthly interviews. Range of motion was measured once only for cases. Their pain intensity (P < 0.009) and demoralization (P < 0.04) were significantly greater in the peak dark months than in the peak light months. There was a non-significant trend (P < 0.07) toward elevated demoralization in the darker months for controls. Range of motion, assessed cross-sectionally, did not demonstrate a seasonal pattern. These data support our prior finding that myofascial face pain and depressed mood are co-morbid and may be maintained by common risk factors.