Changing face of orofacial pain: The diagnostic impact of working with Neurology on an orofacial pain clinic

Publication date: Available online 13 December 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): A. Karamat, J.G. Smith, G. Lambru, T. Renton

Abstract

This study assessed the impact of collaborative working with a headache neurologist on diagnoses of patients attending orofacial pain (OFP) clinic. Patient diagnostic data was collected from adult patients attending an Orofacial Pain Service from January 2013 to January 2017. A liaison headache neurologist was appointed late 2015; OFP clinics were co-run with the neurologist specialist thereafter. Overall, 639 patients attended the service; 315 in 2013–2015 and 324 in 2016–2017. Compared to 2013–2015, there were increased rates of diagnoses related to neurovascular (27.5% vs. 19.0%; P = .012) and musculoskeletal pain (36.9% vs. 26.0%; P = .003) in the 2016–2017 cohort and decreased rates of neuropathic (55.6% vs. 70.2%; P < .001) and atypical/idiopathic pain (1.3% vs. 5.4%; P = .003) diagnoses. There was a trend towards an increased rate of comorbid diagnoses (26.3% vs. 20.3%; P = .077), especially those relating to headache conditions. The findings suggest that introduction of a specialist headache neurologist into the OFP clinic widened its remit of assessment, increasing recognition of (co-morbid) neurovascular-related pain and decreasing atypical/idiopathic pain diagnoses in patients with complex OFP. The increase rate of musculoskeletal pain diagnosis in the later cohort is likely attributable to service expansion and normalisation of diagnostics reportedly seen in other OFP services.

Statement of clinical relevance: Orofacial pain is a complex diagnosis, it requires a multidisciplinary approach that includes neurological input.

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