Suicidal ideation among patients with facial pain disorders

Facial pain can be severely debilitating. Although etiologies vary, facial pain commonly results in diminished quality of life and a pronounced psychosocial burden.

To determine whether severe facial pain is associated with a heightened risk of suicidal ideation.

We performed a retrospective review of patients with facial pain disorders who, during a presurgical evaluation, completed the Columbia-Suicide Severity Rating Scale and Brief Pain Inventory-Facial (BPI-Facial) scale, which assess suicidal risk and the effect of facial pain on quality of life, respectively. To evaluate the independent association between components of the BPI-Facial scale and suicidal thoughts or behaviors, we constructed a series of multivariable logistic regression models. Further classification and k-means clustering techniques were used to predict individual instances of suicidal ideation and to group distinct phenotypes of facial pain, respectively.

We identified 181 patients with facial pain who met the inclusion criteria. The most common cause of facial pain was trigeminal neuralgia (78.5%). Within our cohort, 13.3% of patients reported some degree of suicidal ideation in the Columbia-Suicide Severity Rating Scale questionnaire, a rate approximately 3 times higher than the estimated prevalence in the general adult population. This heightened risk of suicide was associated with considerable pain-related impairments reported in the BPI-Facial scale across the following tested domains: pain intensity, interference in general activities, and interference in face-specific activities.

Our results suggest that facial pain can have highly detrimental effects on patient well-being. Moreover, quantifying facial pain-related impairments may assist in developing targeted interventions and longitudinal screening for mitigating the heightened risk of suicide among those with facial pain disorders.