Biopsychosocial assessment and management of persistent orofacial pain

Abstract

AbstractPersistent orofacial pain (OFP) presents as a range of conditions of complex aetiology which include interacting biological, psychological and social aspects. Biopsychosocial factors have an impact on the development, maintenance and severity of pain disorders as well as on their treatment. Since OFP is unlikely to be cured, given current knowledge, patients need to play an active role in using strategies to reduce their pain or the impact it has on their life. This is known as self‐management and provides a firm foundation for tailored medical management strategies. Biopsychosocial considerations have an important role in supporting successful self‐management. This review describes biopsychosocial factors that may be important to consider in routine care settings. Psychological factors that are known to affect outcome include anxiety and depression and, more specifically catastrophising and self‐efficacy. Research into pain management in other conditions also stresses the importance of psychological flexibility, the ability to respond in a helpful way even when this involves maintaining awareness of difficult feelings and thoughts. Patients' understanding of their pain, including beliefs about its meaning and how it should be managed is also important. Social factors include communication and relationship‐building in clinic, both of which are key. Outside the clinic, other social factors might compromise a patients’ ability to engage in treatment, and clinicians need to be alert to their possible presence. Suggestions are made for incorporating biopsychosocial principles into routine assessment and treatment and for deciding when specialist referral to psychology services might be required.