An evaluation of the diagnosis, treatment, and outcome of patients with chronic orofacial pain.

A review of the records and follow-up of 106 patients who had been referred to pain management clinics in Auckland between January 1990 and October 1992 because of chronic, protracted, orofacial pain, showed that more than half gained lasting benefit. This is consistent with the experience of other interdisciplinary pain clinics dealing with various chronic pain disorders, where previous and often multiple treatments have proved unsuccessful. The patients who made good progress tended to be those motivated to take charge of, and responsibility for, their own rehabilitation. Those patients still seeking a "cure", or who felt it was not up to them to take an active part in the management of their pain problem, tended to make poor or no progress. Of concern was the number of instances of misdiagnosis seen, resulting in inappropriate and, on occasion, harmful treatments. On average, the patients had consulted three general or specialist dental or medical practitioners before referral. Chronic pain problems usually require considerable time and a multidisciplinary environment for accurate diagnoses, and a carefully planned management programme. Often, neither are readily available to the busy general practitioner, whose training and experience is directed toward the treatment of acute pain. As a result, patients with chronic pain often end up treated with methods more appropriate for acute pain, which may entrench and compound the pain problem and lead to permanent disability. Recognition and referral of the patient with chronic pain at an early stage can improve the chances of successful management, and avoid frustration and disillusionment of both the practitioner and the patient.(ABSTRACT TRUNCATED AT 250 WORDS)