Abstract
Introduction: Pain is an unpleasant experience with both sensory and emotional components. Its management is complex due to various factors involved in pain perception by individuals. This is explored in my thesis in three stages. Firstly, a systematic review was carried out to explore the impact of psychological factors in patients with chronic orofacial pain. Secondly, differences in the psychosocial functioning of patients with various chronic orofacial pain conditions were explored. Lastly, a study was conducted to assess the impact of collaborative working with a neurologist specialising in headaches on diagnoses.Methods: For the systematic review, a systematic online search was performed from 2006-2016. Forty-three studies were selected exploring anxiety and or depression. For the second and third projects, data were collected both retrospectively and prospectively from adult patients attending Orofacial Pain Clinic, at Kings College London Hospital, from January 2013 to January 2017.
Results: The systematic review showed severe to moderate depression (25.7%-46.7%) / anxiety (51.2%-54.3%) was associated with chronic orofacial pain levels and severity. Prospective data demonstrated possible anxiety disorder in 34% of neuropathic cases, 31.7% in the TMD group and 53.3% in the neurovascular group. Possible depressive symptoms in the neuropathic pain group were identified in 36.80% of cases, for TMD, in 23.10% of cases and for neurovascular in 42.60%. In the last project, an increased rate of diagnoses related to neurovascular (27.5% vs 19.0%) pain was observed in the 2016-2017 cohort. Decreased rates of neuropathic (55.6% vs 70.2%) and atypical/idiopathic pain (1.3% vs 5.4%) diagnoses were observed.
Discussion: Chronic orofacial pain significantly impacts the psychological well-being of individuals. Multidisciplinary input from psychology and neurology in chronic orofacial pain management is beneficial. Those with a neurovascular cause were highlighted as a subgroup that may require particularly intense psychological input.
| Date of Award | 1 Mar 2020 |
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| Original language | English |
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| Supervisor | Tara Renton (Supervisor) |