The Pain–to–Well-Being Relationship in Patients Experiencing Chronic Orofacial Pain

Abstract

Introduction: Orofacial pain features may negatively influence a person's well-being and vice versa. Some aspects of well-being can be measured with axis II instruments that assess patients' psychosocial and behavioral status. The aim of this study was to investigate associations between pain features and psychosocial variables as indicators of well-being.Materials and Methods: Seven hundred ninety-nine anonymized datasets collected using the Web-based Interdisciplinary Symptom Evaluation (WISE) of patients reporting to the Interdisciplinary Orofacial Pain Unit, University of Zurich, between March 19, 2017 and May 19, 2019, were analyzed. Pain features including intensity, number of locations, impact, and duration were evaluated. Psychometric measures assessed pain-related catastrophizing and disability, illness perception, distress, anxiety, depression, injustice experience, dysmorphic concerns, and insomnia.Results: Most patients were between 30 and 59 years old (58.3%), female (69.8%), working (66.0%), and experienced pain for more than 6 months (68.5%). Pain intensities were higher in women than men and higher in disabled than working patients. Scores indicating elevated stress and depression were also observed in disabled patients. The sample prevalence rates of clinically relevant axis II instrument scores were as follows: Graded Chronic Pain Scale for the Head (GCPS-H), 27%; Patient Health Questionnaire 4 (PHQ4), 21%; PHQ9, 21%; Pain Catastrophizing Scale (PCS), 20%; General Anxiety Disorder 7 (GAD7), 15%; Insomnia Severity Index (ISI), 15%; Injustice Experience Questionnaire (IEQ), 14%; GCPS for the Body (GCPS-B), 13%; PHQ for Stress (PHQstr), 6%; and Dysmorphic Concern Questionnaire (DCQ), 2%. Noteworthy results of correlation analysis of the clinically relevant axis II scores and pain measures were as follows: the PHQstr had moderate associations (0.34–0.43) with the sum of pain intensity at rest and during function, number of pain locations, and typical pain intensity. The IEQ scores were moderately associated with typical pain intensity at 0.39. The DCQ scores were moderately associated with pain extension at 0.41.Conclusions: Moderate correlations of certain pain and well-being measures were found in patients reporting clinically relevant stress, injustice experience, and dysmorphic concern, all of which reflect impaired well-being. PHQ4 is suitable for routine distress screening in the clinical setting.

Association Between Coping Strategies and Pain-Related Outcomes Among Individuals with Chronic Orofacial Pain

“…Of the other demographic and clinical characteristics controlled for in the current study, employment stood out in its association with four outcome variables (depression, anxiety, pain intensity, and pain-related disability), with less favorable outcomes associated primarily with being unemployed or a homemaker in the multiple regression models. This supports previous work linking socioeconomic factors 51 and specifically employment status 11 with unfavorable orofacial pain outcomes, and suggests that routinely collecting employment-related information may help improve and optimize care for this patient population, 11 particularly for underserved communities or those who with low socio-economic status. 68…”

“…Second, to evaluate the incremental variance explained by pain catastrophizing, kinesiophobia, and mindfulness, we conducted four separate two-step hierarchical regressions for each of the criterion variables (pain intensity, pain-related disability, anxiety, and depression). For all analyses, step 1 included several theoretically relevant covariates that been previously deemed relevant to pain outcomes in orofacial pain population (ie, gender, education, employment, diagnostic category and pain duration 11 , 51 , 52 ). Step 2 included the pain catastrophizing, kinesiophobia, and mindfulness scores.…”

Orofacial musculoskeletal pain: An evidence-based bio-psycho-social matrix model

“…Analogously, the emotional state partly determines how we appraise or interpret psychosocial burdens and noxious stimuli (Jinich-Diamant et al, 2020;Zorn et al, 2020). In turn, pain modulates cognitive functioning and emotional well-being (Bhalang et al, 2020;Morogiello et al, 2019). From a neuroscience perspective, it is therefore not surprising that nociception correlates with activation of multiple brain systems and networks that overlap with systems attributed to emotion, cognition, beliefs, and ANS activity (Brügger et al, 2012;Gandhi et al, 2020;Wiech et al, 2008;Yin et al, 2020;Zheng et al, 2020).…”

“…Maladaptive cognitive processes, psychological disorders, and psychosocial burdens can increase the likelihood of developing orofacial pain and headache (Asquini et al, 2021;Dinan et al, 2021;Emodi-Perlman et al, 2020;Fillingim et al, 2013;Glaros et al, 2016;Jeong et al, 2021;Khawaja et al, 2015;Reiter et al, 2018;Wieckiewicz et al, 2017;Yap et al, 2002). In clinical practice, it is common to observe a correlation between pain onset and social burdens in the form of chronic daily hassles (e.g., high workload, time pressure, conflicts, financial strains) or traumatic life events (e.g., loss of a loved one, unemployment, migration, domestic violence, injustice experience), other adverse life circumstances, or lack of access to supporting resources (Bhalang et al, 2020;Chandan et al, 2019;Fillingim et al, 1997;Hinwood et al, 2012). It is worth noting that even seemingly pleasurable events can be stressful.…”

“…The exaggerated focus on biological parameters in medicine can partly be explained by the lack of validated instruments to quantify psychosocial J o u r n a l P r e -p r o o f parameters. Still, for comprehensively assessing and managing orofacial pain the use of validated self-report instruments is critical for capturing the various physiological, psychological, and social factors that reciprocally influence one another (Bhalang et al, 2020;Ettlin et al, 2016;Schiffman et al, 2014;Sommer et al, 2019).…”