Chronic orofacial pain and psychological distress: findings from a multidisciplinary university clinic

Chronic orofacial pain (COFP) is a complex condition that requires multidisciplinary management grounded in the biopsychosocial model. This study examined the associations between temporomandibular disorders (TMD) and headache symptoms and psychological factors within a university-based multidisciplinary care setting, providing insight into the integration of mental health in COFP management.

A retrospective review of 162 patient records from the University of Alberta Multidisciplinary Orofacial Pain Clinic (2020-2023) was conducted. Psychological assessments included the Adverse Childhood Experiences (ACE) scale, Pain Catastrophizing Scale (PCS) and Injustice Experience Questionnaire (IEQ). Logistic regression was used to evaluate associations between psychological factors and pain severity.

The cohort (aged 13-93) was predominantly female (84.0%). Fifteen percent declined psychological measures. Significant associations were observed between PCS (p = 0.036) and IEQ (p = 0.005) scores and reported pain severity. Moderate-to-high PCS scores were associated with a 3.67-fold increase in the odds of moderate to severe TMD symptoms (Odds Ratio (OR): 3.67, 95% Confidence Interval (CI): 1.09-12.35), while high PCS scores predicted severe headaches (OR: 3.91, 95% CI: 1.50-10.17, p = 0.005). Elevated IEQ scores were similarly associated with increased odds of severe headaches (OR: 2.76, 95% CI: 1.08-7.05, p = 0.034).

Psychological factors such as pain catastrophizing and perceived injustice are strongly associated with symptom severity of TMD and headache symptoms in COFP. These findings underscore the importance of integrating targeted psychological assessments into multidisciplinary care. Further research should explore barriers to implementation and advance biopsychosocial approaches to improve outcomes for patients with COFP.