The present investigation sought to: (I) determine the attitudes and behaviors in response to facial pain, and (II) identify possible variables which influenced the pain response in 170 patients who sought care at a facial pain clinic. A questionnaire was administered to all patients on their first clinic visit that elicited information about personal background, sociocultural attitudes, sociomedical orientation, level of psychological distress, symptom and treatment history, and previous attitudes and behavioral responses to their pain. Clinical and radiographie examinations were then performed on all individuals. Factor analysis of patients' replies to the 35-item questionnaire about pain attitudes and behaviors revealed two underlying components of their response to facial pain. The first concerned the degree of emotional expressiveness and careseeking activity that characterized the pain response. According to the items which loaded heavily on this factor, a highly emotional response was composed of crying, moaning, complaining, describing the pain sensation as ‘burning,’ being unable to precisely locate the pain, being concerned about the pain's origin, having difficulty eating, and seeking care soon after first feeling the pain and frequently thereafter. The second component of the pain response was a disturbed ability to function and perform usual activities. When in pain, patients could not work properly, could not enjoy themselves and preferred to be alone. The total patient population was then divided on the basis of clinical signs and symptoms into 3 diagnostic groups: myofascial pain dysfunction syndrome (MPDS) (N = 68), ‘organic’ (patients with organic deficits of the temporomandibular joints, such as arthritis, or with typical facial neuralgias (N = 61), and an intermediate group, ‘MPDS-organic’ (patients with signs and symptoms of both MPDS and synovitis of the temporomandibular joints (N = 41). No patients were found with combined symptoms of MPDS and primary neuralgia. Using multiple regression, the patients' perceived severity or intensity of their pain and level of psychological distress were found to be the most important variables influencing both pain response components, emotional expressiveness and interference in functioning caused by pain. This was true regardless of diagnostic group. The more severe the pain and the more distressed the patient, the more emotional were the patients' responses to it and the greater was its impact on the ability to function. These relationships existed when controlling for personal background, sociocultural attitudes, sociomedical orientation, symptom and treatment history variables, and the clinical findings measured in this study. Our results support the findings of other studies of the response to pain, suggesting that patients' reported responses to pain symptoms: (1) reflect the psychological state of the presenter; and (2) are useful measures of severity or intensity of discomfort caused by pain.
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