title: The impact of chronic orofacial pain on daily life: the vulnerable patient and disruptive pain.
abstract: OBJECTIVE
  To identify patient and pain characteristics associated with negative impacts on daily life among patients with chronic orofacial pain (COFP).
  
  
  METHODS
  Medical records of 200 COFP patients were analyzed.
  
  
  RESULTS
  Diagnostic categories included temporomandibular disorders (85; 42.7%), headaches (47; 23.6%), neuropathic pain (37; 18.5%), trigeminal neuralgia (16; 8.0%), and painful posttraumatic trigeminal neuropathy (PTTN) (14; 7.0%). Of these, 47 (23.7%) had medical and 13 (6.5%) had psychiatric comorbidities and 71 (35.7%) experienced physical trauma. Seven (5%) had stopped working, and mean days absent from work was 3.3 ± 19.3. Patients were previously treated by 2.7 ± 1.4 caregivers. Mean scores on a 0-10 scale were as follows: pain (7.13 ± 2.3), sleep quality (6.6 ± 2.4), and quality of life (5.58 ± 3.1). PTTN patients were more likely to quit work (P = .009) and had more days absent from work (mean 24.3; P = .009). We identified patient and pain profiles that predict these poor outcomes. The "vulnerable patient" profile includes health and psychiatric comorbidities and trauma history, particularly PTTN. The "disruptive pain" profile includes severe, continuous, burning, electrical pain accompanied by systemic signs. These profiles intersect in a complex manner, creating a complex feedback loop.
  
  
  CONCLUSIONS
  A multidisciplinary team approach is recommended to manage COFP patients, in order to improve treatment outcomes and avert more serious consequences.
authors.affiliation: Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Haviv
authors.affiliation: Department of Community Dentistry, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Avraham
authors.initials: A
authors.lastname: Zini
authors.affiliation: In Partial Fulfillment of DMD Degree, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Yoni
authors.initials: Y
authors.lastname: Etzioni
authors.affiliation: Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Valeri
authors.initials: V
authors.lastname: Klitinich
authors.affiliation: Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel-Hashomer, Israel; Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel.
authors.forename: Alex
authors.initials: A
authors.lastname: Dobriyan
authors.affiliation: Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Sharav
authors.affiliation: School of Dental Medicine, Rutgers University, Newark, NJ, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Benoliel
authors.affiliation: Department of Oral Medicine, Sedation, and Maxillofacial Imaging, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel; Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel. Electronic address: galit@almoznino.com.
authors.forename: Galit
authors.initials: G
authors.lastname: Almoznino
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D059350:Chronic Pain / Q000209:etiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D005157:Facial Pain / Q000209:etiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires