Care Pathways in Persistent Orofacial Pain

Abstract

Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the "fluidity of the care pathway," in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a "failure to progress," where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the "effects of unmanaged pain," where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.

Oral diseases: a global public health challenge

“…Many adults have poor access to dental care, which means they also must deal with acute and chronic dental pain and diminished quality of life. 92 Population-based studies of 4-week prevalence of all cause oro-facial pain was 26% in the UK, 93 and 53% in Canada. 94 A 2012 report from Brazil estimated that nearly 25% of the adult population had experienced dental pain within the previous six months.…”

Healthcare priorities in patients with chronic facial pain of temporomandibular disorders

“…It seems, however, that patients with chronic pain frequently experience unsatisfactory clinical encounters (Dima et al, 2013; Toye et al, 2013, 2017, 2019). Similarly, previous reports have highlighted notable inconsistencies and inefficiencies in the UK care pathways for patients with chronic orofacial pain resulting in delays in diagnosis and effective treatment (Breckons et al, 2017).…”

“…Frequent clinical engagement seems to be a genuine issue for patients with chronic orofacial pain (COFP). Breckons et al (2017) studied the clinical pathways of patients with COFP in the UK, and suggested that the current pathways do not meet the patients' needs. A major problem identified was the lengthy periods to obtain a diagnosis and adequate treatment from first presenting with the complaints.…”

“…Similarly, previous reports have highlighted notable inconsistencies and inefficiencies in the UK care pathways for patients with chronic orofacial pain resulting in delays in diagnosis and effective treatment (Breckons et al, 2017).…”

How dental teams can help patients with temporomandibular disorders receive general dental care: An International Delphi process

“…Additionally, many patients with TMD also suffer from other extensive and impactful comorbidities, such as primary headache disorders, fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome 6 . Importantly, many patients report their frustration in being unable to receive effective care in a timely manner 7,8 and difficulties in getting healthcare professionals to understand their condition 9 …”