Diagnostic assessment of orofacial pain

PhD ceremony: Mr. G.E. Tjakkes, 14.45 uur, Academiegebouw, Broerstraat 5, Groningen

Thesis: Diagnostic assessment of orofacial pain

Promotor(s): prof. B. Stegenga, prof. L.G.M. de Bont

Faculty: Medical Sciences

Oral and facial pain (orofacial pain) is a common reason for a patient to visit the dentist or physician. Mostly, the diagnostic process will be relatively easy. When pain becomes chronic, diagnostics become obscured due to changes in the nervous system and psychosocial factors, which start to play a more important role.

Irrespective of the complexity of pain, it essentially originates from actual or former tissue damage. This will act as a stimulus, which is processed in the nervous system and will eventually lead to reactions, experiences and behaviour (consequences).So in the pain process, three components are involved: the stimulus, processing and consequences. We therefore introduce the stimulus-processing-consequences (SPC) model as a basis for the assessment of orofacial pain.

In this, diagnostics using pharmacological agents play a major role. These aim predominantly at the stimulus and the processing. Injection of local anesthesia in the temporomandibular joint in patients perceiving pain in the temporomandibular joint area, has a pain relieving effect when compared to placebo injection. Also, a pharmacological test, in which several pharmacological agents are subsequently infused intravenously, seems to be able to differentiate between patients with different pain mechanisms.

The consequences may be judged with the quality of life, which seems to decrease when pain persists. An indiviudal assessment of the quality of life may quickly provide a starting point for further (psychosocial) diagnostic assessment.

By involving different SPC levels simultaneously, a synergystic effect on the efficasy of diagnostics and eventual management of chronic orofacial pain may be accomplished.