Catastrophising, pain self-efficacy and acceptance in patients with Burning Mouth Syndrome.

BACKGROUND: Little is known about pain catastrophising, pain self-efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health-related quality of life (HRQoL) and symptoms of anxiety and depressive disorders. OBJECTIVES: To describe pain catastrophising, pain self-efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL. METHODS: A cross-sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self-Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire-8 in addition to standardised self-reported questionnaires measuring mood and oral and generic HRQoL. RESULTS: Pain catastrophising levels were markedly higher than (non-clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self-efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate-to-strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=-0.84). Self-efficacy and acceptance were also closely related to levels of depression (r/rho=-0.83 to -0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity. CONCLUSIONS: A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self-efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.

The differential impact of neuropathic, musculoskeletal and neurovascular orofacial pain on psychosocial function.

BACKGROUND: While the psychosocial morbidity of orofacial pain (OFP) is widely recognized, the differential impact of musculoskeletal, neuropathic and neurovascular symptoms on pain and psychosocial function in individuals with and without coexisting OFP conditions is unclear. MATERIALS AND METHODS: This was a comparative cross-sectional study of 350 consecutive patients attending an OFP clinic; 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. RESULTS: Two hundred patients were diagnosed with a neuropathic condition: 125 with musculoskeletal pain and 101 with (neurovascular) headache disorders. 23% of patients presented with multiple OFP conditions; this was more common in patients with neurovascular (62%) than neuropathic (21%) and/or musculoskeletal orofacial symptoms (28%). Patients with neurovascular symptoms experienced significantly higher levels of pain, evidenced less pain self-efficacy and had poorer overall health. Neuropathic OFP was significantly associated with greater psychological and social oral health disability. 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. CONCLUSIONS: The profile and degree of psychosocial morbidity in patients with OFP is significantly related to the types of presenting orofacial symptoms. Patients with neurovascular pain present with higher pain levels and have poorer health while those with neuropathic pain have higher oral functional morbidity; both may require more complex multidisciplinary management.

Psychologic Impact of Chronic Orofacial Pain: A Critical Review.

AIMS: To explore the prevalence of clinically significant anxiety and depression in adult patients with chronic orofacial pain (COFP) conditions. METHODS: A systematic online search of the Medline (PubMed) and Ovid databases was performed for articles published from 2006 to 2019. Observational studies- including cross-sectional, case-control, and case series-and longitudinal prospective studies were included. A total of 118 articles were selected for inclusion, and the prevalence rates of clinically significant anxiety and depression were summarized. RESULTS: Most studies focused on temporomandibular disorder (TMD) pain and less often on neuropathic COFP conditions. Prevalence rates varied widely across studies according to OFP condition and assessment measure; most questionnaire-based assessments yielded rates of clinically significant depression and anxiety in, respectively, 40% to 60% and 40% to 65% of individuals with TMD and in 20% to 50% and 25% to 55% of patients with neuropathic, mixed, or idiopathic/atypical COFP conditions. Rates of anxiety and depression were lower in studies using diagnostic instruments and in TMD studies with nonpatient samples. Most controlled studies showed a higher prevalence of anxiety and depression in individuals with COFP than in those without. Higher COFP pain levels and the presence of comorbid conditions such as migraines or widespread pain increased the likelihood of anxiety and/or depressive symptoms in individuals. CONCLUSION: Clinically significant anxiety and depression were commonly observed in patients with COFP, were present at higher rates than in pain-free participants in controlled studies, and were closely linked to pain severity. More research is needed to evaluate the psychologic impact of multiple COFP conditions in an individual and the prevalence of precondition psychologic morbidity.

Comparison of the Neuropathic Pain Symptoms and Psychosocial Impacts of Trigeminal Neuralgia and Painful Posttraumatic Trigeminal Neuropathy.

AIMS: To compare the impacts of trigeminal neuralgia (TN) and painful posttraumatic trigeminal neuropathy (PPTTN) on psychologic function and health-related quality of life (HRQoL) using a comprehensive quantitative assessment. METHODS: This was a comparative cross-sectional study. A total of 97 patients diagnosed with PPTTN and 40 patients diagnosed with TN who sought treatment at an orofacial pain clinic completed standardized self-report measures of pain intensity, neuropathic symptoms, pain self-efficacy, mood, and indicators of general and oral HRQoL. Differences between the PPTTN and TN groups were tested, and associations of each condition with pain severity, psychologic function, and HRQoL were examined. RESULTS: The majority of PPTTN (66%) and TN patients (80%) were affected by orofacial pain. Pain attacks were more frequent in TN (71%) than PPTTN (28%) patients, while numbness was more common in PPTTN (51%) than TN (12%) patients. Pain intensity was higher in TN for intermittent and affective pain dimensions. Both PPTTN and TN had a significant, but comparable, impact on patients' oral HRQoL. The burden of condition on overall health was significantly more pronounced in patients with TN than PPTTN, with evident differences in the mobility and self-care domains. There was a trend showing that more TN (54%) than PPTTN (36%) patients reported signs of depression, but clinically significant anxiety was comparably high in both groups (34% to 39%). Anxiety and pain self-efficacy were closely related to oral and general health statuses in both groups. CONCLUSIONS: Both TN and PPTTN are associated with significant psychosocial burden and reduced HRQoL, indicating a need to develop effective treatments for neuropathic orofacial pain that target functional restoration.