Study Examines Impact of Orofacial Pain Characteristics

Orofacial pain is a complex condition, stemming from multiple factors, that affects physical and psychological health.

A recent study examined the impact of musculoskeletal, neuropathic, and neurovascular symptoms on pain and psychosocial function in patients with and without coexisting orofacial pain (OFP).

OFP is a complex, heterogeneous set of syndromes characterized by facial pain and oral cavity, sensitized through the trigeminal nerve system.

The researchers found that the characteristics and degree of psychosocial morbidity in patients with OFP is significantly related to the types of presenting orofacial symptoms.

Chronic OFP, which is OFP lasting 3 months or more, is often very debilitating, decreasing physical and psychological health, social function, and financial well‐being, the researchers said; in the United Kingdom it has a prevalence rate of about 7%.

A comparative cross‐sectional study examined 350 consecutive patients attending an OFP clinic in south London from February 2016 to January 2017. Patients were aged 18 years and older and mostly female; most (319, 91.1%) were newly referred patients, while 31 (8.9%) were current patients.

Of the 350, 244 completed standardized self‐report measures of pain experience, mood, and generic and oral health‐related quality of life (HRQoL). The impact of musculoskeletal, neuropathic and neurovascular symptoms on measures was assessed using linear and logistic generalized linear models.

Two hundred patients were diagnosed with a neuropathic condition: 125 with musculoskeletal pain and 101 with (neurovascular) headache disorders.

Almost 1 in 4 patients (77, 22.5%) presented with more than 1 type of orofacial symptom. Three percent of patients had multiple OFP conditions. This was more likely in patients with neurovascular (62%) than neuropathic (21%) and/or musculoskeletal orofacial symptoms (28%).

Patients with neuropathic symptoms tended to be older and had temporomandibular (TMD) disorders; TMD was significantly associated with comorbid chronic body pain (OR = 2.38; CI = 1.15-4.89; P = .019).

The comorbidity of headache disorders with TMD is well known and is likely a result of overlapping nociceptive systems, peripheral and central sensitization processes in the trigeminal nerve network common to both conditions, and/or shared genetic risk.

Researchers also found that a high proportion of patients with headache disorders had comorbid musculoskeletal OFP, and less frequently, comorbid neuropathic OFP.

Patients with neurovascular symptoms experienced significantly higher levels of pain, evidenced less pain self‐efficacy, and had poorer overall health. Neuropathic OFP, meanwhile, was significantly associated with greater psychological and social oral health disability.

The researchers found that multiple OFP symptoms were not linked to pain severity or psychosocial function, although health scores were worse for patients with neurovascular pain and neuropathic/musculoskeletal symptoms compared with patients with only neurovascular symptoms.

Both types of patients—those with primarily neurovascular pain and those with primarily neuropathic pain, may require more complex multidisciplinary management, the researchers said

Reference

Smith JG, Karamat A, Melek LN, Jayakumar S, Renton T. The differential impact of neuropathic, musculoskeletal and neurovascular orofacial pain on psychosocial function. J Oral Pathol Med. 2020;49(6):538-546. doi: 10.1111/jop.13071