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

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.