title: Managing chronic orofacial pain: A qualitative study of patients', doctors', and dentists' experiences.
abstract: OBJECTIVE
  Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners.
  
  
  METHODS
  Qualitative interview study.
  
  
  METHODS
  Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed.
  
  
  RESULTS
  Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a diagnosis proved problematic but largely functional for both parties. GPs and dentists viewed COFP as a non-dental problem and felt inadequately equipped to manage the condition. GPs, unlike dentists, felt obligated to support patients using techniques for managing patients with other long-term conditions. Frustration at the current inadequacy of COFP management often led to conflict with (or disengagement from) the clinician-patient relationship.
  
  
  CONCLUSIONS
  Current management of COFP is ineffective and unsatisfactory for patients and practitioners, which impacts on their relationship. Fundamental barriers to accessing and implementing psychological interventions for COFP arise from ineffective communication between physicians and patients, and between medical and dental practitioners. Statement of contribution What is already known on this subject? COFP is characterized by persistent pain in the face, mouth, or jaws that are not the result of organic disease or physical trauma. Patients with COFP present to both medical and dental services and receive sub-optimal care. No studies have examined the experiences of managing this problem from the perspectives of dentists, general practitioners and patients. What does this study add? Patients, dentists, and GPs recognize the role that psychological factors have in maintaining and addressing facial pain symptoms, yet principally manage it through biomedical interventions. Challenges exist over arriving at a diagnosis and managing the problem, and challenges are exacerbated by poor communication between doctors and medical services. Improvements are needed in liaison between medical and dental services and further training to support primary care clinicians to facilitate a stepped care approach to managing COFP.
authors.affiliation: Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Peters
authors.affiliation: School of Dentistry, University of Manchester, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Goldthorpe
authors.affiliation: School of Dentistry, University of Manchester, UK.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McElroy
authors.affiliation: Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: King
authors.affiliation: School of Clinical Dentistry, University of Sheffield, UK.
authors.forename: Hanieh
authors.initials: H
authors.lastname: Javidi
authors.affiliation: School of Dentistry, University of Manchester, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Tickle
authors.affiliation: School of Dentistry, University of Manchester, UK.
authors.forename: Vishal R
authors.initials: VR
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D003815:Dentists; D005157:Facial Pain / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians; D019239:Practice Patterns, Dentists'; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D055815:Young Adult
keywords: chronic orofacial pain; chronic pain; clinical communication; dentistry; medically unexplained symptoms