Advancements in Understanding and Classifying Chronic Orofacial Pain: Key Insights from Biopsychosocial Models and International Classifications (ICHD-3, ICD-11, ICOP)

Abstract

In exploring chronic orofacial pain (COFP), this review highlights its global impact on life quality and critiques current diagnostic systems, including the ICD-11, ICOP, and ICHD-3, for their limitations in addressing COFP's complexity. Firstly, this study outlines the global burden of chronic pain and the importance of distinguishing between different pain types for effective treatment. It then delves into the specific challenges of diagnosing COFP, emphasizing the need for a more nuanced approach that incorporates the biopsychosocial model. This review critically examines existing classification systems, highlighting their limitations in fully capturing COFP's multifaceted nature. It advocates for the integration of these systems with the DSM-5's Somatic Symptom Disorder code, proposing a unified, multidisciplinary diagnostic approach. This recommendation aims to improve chronic pain coding standardization and acknowledge the complex interplay of biological, psychological, and social factors in COFP. In conclusion, here, we highlight the need for a comprehensive, universally applicable classification system for COFP. Such a system would enable accurate diagnosis, streamline treatment strategies, and enhance communication among healthcare professionals. This advancement holds potential for significant contributions to research and patient care in this challenging field, offering a broader perspective for scientists across disciplines.

Keywords: Diagnostic and Statistical Manual of Mental Disorders (DSM-5); International Classification of Diseases (ICD-11); International Classification of Headache Disorders (ICHD-3); International Classification of Orofacial Pain (ICOP); biopsychosocial; burning mouth syndrome; chronic pain; models; orofacial pain; toothache/diagnosis; trigeminal neuralgia.

Figure 1

The biopsychosocial model of pain. The experience of pain is personal because it is mediated by the dynamic, interdependent, and synergistic integration of three factors/domains: biological factors, psychological factors, and social factors. Each domain may have characteristics shared with the others. Biological factors that can negatively affect the perception of pain include traumatic injury, the severity of overall health conditions, and genetic/hormonal predisposition. Psychological factors that can amplify pain include anxiety, depression, sleep disorders, excessive catastrophizing, and low self-efficacy. Social factors that can negatively influence the perception of pain include gender roles, ethnic identity, discrimination, poor family support, and healthcare provider prejudice.

Figure 2

Classification of the three main types of orofacial pain according to ICD-11. Under the new concept of multiple parenting in ICD-11, each entity can be assigned to other divisions of the classification of chronic pain. In ICD-11, persistent idiopathic facial pain is referred to as atypical facial pain.

Figure 3

Classification and coding of chronic orofacial pain disorders. Abbreviations—BMS: burning mouth syndrome; PIFP: persistent idiopathic facial Pain; PIDP: persistent idiopathic dento-alveolar pain; TN: trigeminal neuralgia; SSD: somatic symptom disorder; ICOP: International Classification of Orofacial Pain (2020 Edition); ICHD-3: International Classification of Headache Disorders (3rd Edition); ICD-11: International Classification of Diseases (11th Revision); DSM-5: Diagnostic and Statistical Manual of Mental Disorders (5th Edition).