Document Type : Original Article
Authors
Department of Oral Medicine and Radiology, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth Deemed to Be University, Gujarat, India
Abstract
Background: Chronic orofacial pain (OFP) is a serious public health issue that significantly affects the quality of life of patients, contributing to anxiety, anger, and depression. While many studies have focused on the quantitative assessment of pain, very few have addressed the quality of life in these patients. Qualitative research offers a naturalistic, interpretive approach to explaining or understanding human experience. Accordingly, this study aimed to explore patients’ experiences with chronic OFP.
Methods: This qualitative study involved 16 patients with chronic OFP. A phenomenological approach was adopted to foreground the subjective experiences of individuals. In-depth interviews, lasting 60-120 minutes, were conducted using open-ended questions about experiences of symptoms, treatments, and living with OFP. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was employed to identify themes across biomedical, psychological, and social dimensions. Following coding, representative quotes were presented to illustrate the themes.
Results: Analysis revealed several themes and subthemes demonstrating the significant impact of chronic OFP on quality of life. Deprivation of social contacts led to feelings of helplessness and disbelief among family members and to loss of employment. Adverse cognitive effects impaired coping with pain and were associated with physical agony, taste alteration, and inability to perform routine activities. Disbelief in the healthcare system was a major agony, influenced by prolonged medication use, multiple referrals, and perceived lack of empathy from physicians.
Conclusion: This qualitative study provided an in-depth analysis of patients’ experiences of living with chronic OFP. Cognitive, social, and cultural factors can alter pain coping mechanisms, pain perception, and trust in the healthcare system. The findings from this study highlighted gaps in current care and suggested that comprehensive management, potentially including cognitive-behavioral therapy, lifestyle modifications, and alternative treatment modalities, along with occupational therapy and timely referral to pain specialists, may support holistic healing and improve functioning.
Highlights
Deepa Jatti Patil (PubMed) (Google Scholar)
Keywords
- de Leeuw R, Fernandez-Vial D. Challenges for the dentist in managing orofacial pain. Dent Clin North Am. 2023;67(1):173- 85. doi: 10.1016/j.cden.2022.07.013.
- Häggman-Henrikson B, Liv P, Ilgunas A, Visscher CM, Lobbezoo F, Durham J, et al. Increasing gender differences in the prevalence and chronification of orofacial pain in the population. Pain. 2020;161(8):1768-75. doi: 10.1097/j. pain.0000000000001872.
- Oberoi SS, Hiremath SS, Yashoda R, Marya C, Rekhi A. Prevalence of various orofacial pain symptoms and their overall impact on quality of life in a tertiary care hospital in India. J Maxillofac Oral Surg. 2014;13(4):533-8. doi: 10.1007/ s12663-013-0576-6 .
- Romero-Reyes M, Uyanik JM. Orofacial pain management: current perspectives. J Pain Res. 2014;7:99-115. doi: 10.2147/ jpr.S37593.
- Von Korff M, DeBar LL, Krebs EE, Kerns RD, Deyo RA, Keefe FJ. Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain. Pain. 2020;161(3):651-61. doi: 10.1097/j.pain.0000000000001758.
- Aggarwal VR, Macfarlane GJ, Farragher TM, McBeth J. Risk factors for onset of chronic oro-facial pain--results of the North Cheshire oro-facial pain prospective population study. Pain. 2010;149(2):354-9. doi: 10.1016/j.pain.2010.02.040.
- Closs SJ, Staples V, Reid I, Bennett MI, Briggs M. The impact of neuropathic pain on relationships. J Adv Nurs. 2009;65(2):402- 11. doi: 10.1111/j.1365-2648.2008.04892.x.
- Chandra A, Ozturk A. Quality of life issues and assessment tools as they relate to patients with chronic nonmalignant pain. Hosp Top. 2005;83(1):33-7. doi: 10.3200/HTPS.83.1.33-37.
- Durham J, Shen J, Breckons M, Steele JG, Araujo-Soares V, Exley C, et al. Healthcare cost and impact of persistent orofacial pain: the DEEP study cohort. J Dent Res. 2016;95(10):1147- 54. doi: 10.1177/0022034516648088.
- Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev. 2011(11):CD008456. doi: 10.1002/14651858.CD008456. pub2.
- Ebrahimi E, Mohammadi Shirmahaleh F, Mardani Hamooleh M, Habibi Asgarabad M. Iranian obese women’s lived experiences of Social and linguistic factors shaping emotional eating behavior: a phenomenological study. J Qual Res Health Sci. 2023;12(4):195-200. doi: 10.34172/jqr.2023.28.
- Smith JA, Larkin M, Flowers P. Interpretative Phenomenological Analysis: Theory, Method and Research. Los Angeles, CA: SAGE Publications; 2009.
- Hazaveh M, Hovey R. Patient experience of living with orofacial pain: an interpretive phenomenological study. JDR Clin Trans Res. 2018;3(3):264-71. doi: 10.1177/2380084418763317.
- Wolf E, Nilner M, Petersson K. Non-specific chronic orofacial pain patients’ experiences of everyday life situations: a qualitative study. Swed Dent J. 2016;40(2):213-22.
- Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, et al. The IASP classification of chronic pain for ICD- 11: chronic neuropathic pain. Pain. 2019;160(1):53-9. doi: 10.1097/j.pain.0000000000001365.
- Scientific software development. Atlas ti.1-8 Berlin. Available from: https://atlasti.com/.
- Dueñas M, Salazar A, de Sola H, Failde I. Limitations in activities of daily living in people with chronic pain: identification of groups using clusters analysis. Pain Pract. 2020;20(2):179-87. doi: 10.1111/papr.12842.
- Lagueux É, Dépelteau A, Masse J. Occupational therapy’s unique contribution to chronic pain management: a scoping review. Pain Res Manag. 2018;2018:5378451. doi: 10.1155/2018/5378451.
- Lovette BC, Bannon SM, Spyropoulos DC, Vranceanu AM, Greenberg J. “I still suffer every second of every day”: a qualitative analysis of the challenges of living with chronic orofacial pain. J Pain Res. 2022;15:2139-48. doi: 10.2147/jpr. S372469.
- Wolf E, Birgerstam P, Nilner M, Petersson K. Nonspecific chronic orofacial pain: studying patient experiences and perspectives with a qualitative approach. J Orofac Pain. 2008;22(4):349-58.
- Krapp K, Longe JL. The Gale Encyclopedia of Alternative Medicine. Vol 3. Detroit: Gale Group; 2001. p. 1449-51.
- Alrashdan MS, Alkhader M. Psychological factors in oral mucosal and orofacial pain conditions. Eur J Dent. 2017;11(4):548-52. doi: 10.4103/ejd.ejd_11_17.
- Forssell H, Teerijoki-Oksa T, Puukka P, Estlander AM. Symptom severity in burning mouth syndrome associates with psychological factors. J Oral Rehabil. 2020;47(6):713-9. doi: 10.1111/joor.12966.
- Sójka A, Stelcer B, Roy M, Mojs E, Pryliński M. Is there a relationship between psychological factors and TMD? Brain Behav. 2019;9(9):e01360. doi: 10.1002/brb3.1360.
- Moisak GI, Amelina EV, Zubok NA, Rzaev JA. Psychological status before and after surgery in patients with trigeminal neuralgia. Clin Neurol Neurosurg. 2021;203:106578. doi: 10.1016/j.clineuro.2021.106578.
- Greenberg J, Popok PJ, Lin A, Kulich RJ, James P, Macklin EA, et al. A mind-body physical activity program for chronic pain with or without a digital monitoring device: proof-of-concept feasibility randomized controlled trial. JMIR Form Res. 2020;4(6):e18703. doi: 10.2196/18703.
- Goldthorpe J, Peters S, Lovell K, McGowan L, Aggarwal V. ‘I just wanted someone to tell me it wasn’t all in my mind and do something for me’: qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain. Br Dent J. 2016;220(9):459-63. doi: 10.1038/sj.bdj.2016.332.
- Noma N, Watanabe Y, Shimada A, Usuda S, Iida T, Shimada A, et al. Effects of cognitive behavioral therapy on orofacial pain conditions. J Oral Sci. 2020;63(1):4-7. doi: 10.2334/ josnusd.20-0437.
- Barker S, Urbanek M, Penlington C. Psychological interventions for persistent orofacial pain. Prim Dent J. 2019;7(4):30-5.
- Renton T. Summary of: retrospective examination of the healthcare ‘journey’ of chronic orofacial pain patients referred to oral and maxillofacial surgery. Br Dent J. 2013;214(5):236- 7. doi: 10.1038/sj.bdj.2013.246.
- Mohr G, von Piekartz HJ, Hotze E. A qualitative study on pain experiences and pain behavior in patients with chronic facial pain. Journal of Craniomandibular Function. 2011;3(1):9-28.
- Au TS, Wong MC, McMillan AS, Bridges S, McGrath C. Treatment seeking behaviour in southern Chinese elders with chronic orofacial pain: a qualitative study. BMC Oral Health. 2014;14:8. doi: 10.1186/1472-6831-14-8.
- Peters S, Goldthorpe J, McElroy C, King E, Javidi H, Tickle M, et al. Managing chronic orofacial pain: a qualitative study of patients’, doctors’, and dentists’ experiences. Br J Health Psychol. 2015;20(4):777-91. doi: 10.1111/bjhp.12141.
- Sharifi Ardani A, Yarmohammadian A, Ghamrani A. Exploring the lived experiences of mothers of children with intellectual disability: a phenomenological approach. J Qual Res Health Sci. 2022;11(2):83-91. doi: 10.22062/jqr.2022.91935.
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