A profile of patients presenting with non-odontogenic pain to a orofacial pain clinic in Korea

Abstract

Etiology as well as diagnosis and treatment methods for non-odontogenic (NO) pain have not yet been clearly established. Patients with NO pain generally have complex histories of dental treatment without improvement of symptoms. Patients often suffer from persistent pain because of failure to establish the NO etiology, resulting in incorrect diagnosis and inappropriate dental treatment unnecessary to resolving NO pain. Despite this issue, NO pain has not been systemically evaluated in Korea. This study therefore investigated the various clinical profiles of patients with NO pain as well as diagnosis and treatment methods of NO pain. Subjects included 210 patients with orofacial pain complaints who were admitted to the Department of Orofacial Pain and Oral Medicine of Yonsei University Dental Hospital between May 2003 and April 2013. Chart reviews were conducted on all 210 patients. The profiles were evaluated using patient charts (gender, age, smoking, alcohol consumption, systemic disease, pain duration, pain location, and areas affected by pain) and surveys (pain intensity, spontaneity of pain, referred pain, and dental history associated with the NO pain). Based on the obtained results, we report the following findings: 1. NO pain was diagnosed mainly as neuropathic pain (53.8%) and myofascial pain (MFP) (23.3%). 2. There were 65.7% without medical history, 20.5% cardiovascular diseases, 6.7% with GI troubles and 4.3% with psychogenic diseases. And only few of them have smoking (male 6.7%, female 1.0%) and drinking habits (male 8.6%, female 5.7%). 3. The common site of NO pain is left maxilla (30.0%), and right maxilla (27.6%). Distribution of affected area were generally in accordance with previous reports but was not predominant in maxillary posterior region. Single area was affected in 90 patients (42.9%) with similar occurrence with multiple lesions (41.0%). 4. 17 patients (8.1%) had referred pain. 63.8% of patients have spontaneous pain. And the number of patients who have severe pain and who have moderate pain were 24.3%, 51.9% each. The average period of treatment was 6.7 months. 5. NO pain occurs more often to the female (74.8%) than to the male (25.2%). The average age is 49.0 years and the average pain duration is 31 months. 6. Considering the departments referring to the Department of Orofacial Pain and Oral Medicine, treatments related to NO pain, previous dental treatment history, and visiting dental departments, NO pain is very closely related to the RCT. 48.6% of patients have treated more than 3 dentists. 7. The used drugs were mainly antidepressants (42.9%) and anticonvulsants (38.9%). And the effectiveness of anticonvulsants (79.2%) is better than that of antidepressants (75.3%). 8. Mainly the treatment drugs of neuropathic pain used amitriptyline (18.9%) and gabapentin (14.1%). And topical capsaicin has a limited effect. 9. Mainly the treatment drugs of MFP used eperisone HCl (24.3%) and cyclobenzaprine HCl (13.6%).