Psychologic Impact of Chronic Orofacial Pain: A Critical Review

Abstract

Aims: To explore the prevalence of clinically significant anxiety and depression in adult patients with chronic orofacial pain (COFP) conditions.

Methods: A systematic online search of the Medline (PubMed) and Ovid databases was performed for articles published from 2006 to 2019. Observational studies- including cross-sectional, case-control, and case series-and longitudinal prospective studies were included. A total of 118 articles were selected for inclusion, and the prevalence rates of clinically significant anxiety and depression were summarized.

Results: Most studies focused on temporomandibular disorder (TMD) pain and less often on neuropathic COFP conditions. Prevalence rates varied widely across studies according to OFP condition and assessment measure; most questionnaire-based assessments yielded rates of clinically significant depression and anxiety in, respectively, 40% to 60% and 40% to 65% of individuals with TMD and in 20% to 50% and 25% to 55% of patients with neuropathic, mixed, or idiopathic/atypical COFP conditions. Rates of anxiety and depression were lower in studies using diagnostic instruments and in TMD studies with nonpatient samples. Most controlled studies showed a higher prevalence of anxiety and depression in individuals with COFP than in those without. Higher COFP pain levels and the presence of comorbid conditions such as migraines or widespread pain increased the likelihood of anxiety and/or depressive symptoms in individuals.

Conclusion: Clinically significant anxiety and depression were commonly observed in patients with COFP, were present at higher rates than in pain-free participants in controlled studies, and were closely linked to pain severity. More research is needed to evaluate the psychologic impact of multiple COFP conditions in an individual and the prevalence of precondition psychologic morbidity.

Fig 1

Flow diagram of study selection.

Fig 2

(a) Depression and (b) anxiety across TMD studies. Studies are ordered according to TMD condition, depression/anxiety measure, and percentage of depression/anxiety reported. DD = disc displacement; HA = headache. See other abbreviations in Table 1 legend.

Fig 2

(a) Depression and (b) anxiety across TMD studies. Studies are ordered according to TMD condition, depression/anxiety measure, and percentage of depression/anxiety reported. DD = disc displacement; HA = headache. See other abbreviations in Table 1 legend.

Fig 3

Rates of (a) depression and (b) anxiety across neuropathic, mixed, and idiopathic/atypical orofacial pain (OFP) condition studies. Studies are ordered according to OFP condition, depression/anxiety measure, and percentage of depression/anxiety reported. CH = chronic; FP = facial pain. See other abbreviations in Table 1 legend.

Fig 3

Rates of (a) depression and (b) anxiety across neuropathic, mixed, and idiopathic/atypical orofacial pain (OFP) condition studies. Studies are ordered according to OFP condition, depression/anxiety measure, and percentage of depression/anxiety reported. CH = chronic; FP = facial pain. See other abbreviations in Table 1 legend.