Peters Sarah, Goldthorpe Joanna, McElroy Cheryl, King Elizabeth, Javidi Hanieh, Tickle Martin, Aggarwal Vishal R
Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, UK.
School of Dentistry, University of Manchester, UK.
Br J Health Psychol. 2015 Nov;20(4):777-91. doi: 10.1111/bjhp.12141. Epub 2015 Apr 20.
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.
Qualitative interview study.
Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed.
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.
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.
面部、口腔和颌部的持续性疼痛是牙科和医疗服务中常见的症状。其病因尚不清楚，但越来越多的证据表明心理干预而非生物医学干预具有有效性。为了解如何将这种方法应用于临床实践，需要了解患者以及临床医生对慢性口面部疼痛（COFP）的体验。本研究的目的是探讨患者、初级和二级医疗及牙科从业者对COFP的体验和理解。
定性访谈研究。
对12名牙医、11名全科医生和7名患者的有目的样本进行了音频记录的半结构化访谈，并进行了主题分析。
临床医生和患者认识到心理因素在COFP的发生和维持中可能发挥的作用，但管理和自我管理策略在很大程度上仅限于生物医学干预。做出诊断存在问题，但对双方来说在很大程度上仍能发挥作用。全科医生和牙医将COFP视为非牙科问题，并认为自己没有足够的能力来处理这种情况。与牙医不同，全科医生感到有义务使用管理其他慢性病患者的技术来支持患者。对目前COFP管理不足的沮丧常常导致与医患关系产生冲突（或脱离这种关系）。
目前对COFP的管理对患者和从业者来说既无效又不令人满意，这影响了他们之间的关系。COFP心理干预的获取和实施存在根本障碍，源于医生与患者之间以及医疗和牙科从业者之间的无效沟通。贡献声明关于这个主题已知的内容有哪些？COFP的特征是面部、口腔或颌部的持续性疼痛，并非由器质性疾病或身体创伤引起。COFP患者会同时寻求医疗和牙科服务，且得到的护理并不理想。尚无研究从牙医、全科医生和患者的角度考察处理这个问题的体验。本研究增加了什么内容？患者、牙医和全科医生认识到心理因素在维持和解决面部疼痛症状中所起的作用，但主要通过生物医学干预来处理。在做出诊断和处理问题方面存在挑战，而医生与医疗服务之间的沟通不畅使这些挑战更加严峻。医疗和牙科服务之间的联络需要改进，并且需要进一步培训以支持初级保健临床医生，从而促进采用分级护理方法来管理COFP。
