Chronic orofacial pain. Understanding patients from two perspectives: the clinical view and the patient's experience

The aim of this thesis was to study chronic orofacial pain patients from two perspectives--the clinical view and the experience of the patient--in order to improve the understanding of the patients and their condition. All patients had been referred to the Faculty of Odontology, Malmö University, Malmö, Sweden owing to chronic orofacial pain. The clinical perspective was investigated in a retrospective study of 109 consecutive chronic orofacial pain patients (85 females, 24 males) who had been examined by a pain group. Diagnosis, pain status, medication, and education were the parameters studied and pain-related sex differences were calculated. In addition, the patients were mailed a questionnaire after 4-9 years to follow up their pain status and to identify predictors of pain persistence. The patient perspective was investigated by interviewing 14 strategically selected patients (11 female, 3 male) about their lived experience of non-specific chronic orofacial pain. The interviews were of 1-1.5-hour duration and were conducted twice with each patient. The findings from the clinical studies and the interview studies are listed below. The experiences of the interviewed patients revealed additional aspects of several of the findings made in the clinical studies. The majority of the patients were female. Mainly similarities between the sexes were found regarding pain status and the other parameters studied. The patients had a lower level of education than Swedish inhabitants of the same ages. The majority of the patients in the clinical studies reported seeking care repeatedly owing to orofacial pain. The patients in the interview studies experienced distrust and rejection at the consultations for the orofacial pain. They also experienced the pain as elusive and difficult to communicate. Most of the patients in the clinical studies had persistent pain of some intensity at the follow-up 4-9 years later. The interviewed patients expressed a great need to be taken care of and often seemed to have a limited ability to cope with the pain. Among the patients studied clinically, a reported consumption of pharmacological agents with a central effect (opioids, muscle relaxants, antidepressants, neuroleptics, hypnotics, or sedatives) was a predictor of pain persisting at the follow-up. The interviewed patients expressed feelings of hopelessness and a lack of faith in the future. To study patients with chronic orofacial pain from a clinical viewpoint and from a patient perspective led to a deeper understanding of chronic orofacial pain as a complex condition that has an impact on every aspect of the patient's life. The patients often seek dental care because of the pain. It seems to be important in dentistry to develop constructive strategies for caring for these patients--especially when the dental disease condition has already been adequately diagnosed and treated, but the patients still experience pain.