Orofacial pain in Southern Chinese people: Predictors of outcome

Orofacial pain (OFP) is often acute in nature, however, in some instances it tends to persist. Factors that predict persistent OFP in Chinese people are presently unclear. Objectives: To investigate the natural history of OFP in community-dwelling adult Chinese people in Hong Kong over a 6-month period and to identify factors that predict poor outcome. Methods: A cross-sectional case-control and prospective study was conducted using HKU's Family Medicine Unit as the sampling frame. The study involved 400 participants (aged 35-70 years; 146 males, 254 females) at baseline assessment of whom 200 reported OFP. Standard questions were asked about OFP symptoms and characteristics in the previous month and the OHIP-14, GHQ-12, RDC/TMD depression/NPS scales, sleep and illness behaviour measures and pain-disability questions were administered prior to a standard clinical assessment. Participants with pain at baseline were followed up 6-months later and questionnaire/clinical assessments repeated. The McNemar test was used to assess differences in OFP symptoms and conditions between baseline and 6-month follow-up. Cox regression was employed to estimate relative risk. A forward stepwise model incorporating 30 variables was used to identify independent factors predicting outcome at 6-months. Results: 122 of those with OFP at baseline participated at the 6-month evaluation and 89 of them had persistent OFP. The distribution of OFP symptoms/conditions was generally similar between baseline and follow-up (P>0.05). However, TMD and burning mouth conditions and symptoms at multiple sites decreased at follow-up (P<0.017). Participants with depression (moderate or severe level) at baseline had a higher risk of having persistent pain at follow-up (RR, 1.6; 95% C.I., 1.06-2.45). Conclusion: Persistent OFP was common in Southern Chinese people and was associated with depression at baseline. The findings have implications for the management of persistent OFP in this ethnic group as treatment of physical symptoms alone may be unsuccessful. Supported by CRCG-HKU.