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Pain 99 (2002) 453–458 www.elsevier.com/locate/pain

Orofacial pain: just another chronic pain? Results from a population-based survey
Tatiana V. Macfarlane a, Anthony S. Blinkhorn a, Robin M. Davies a, Philip Ryan b, Helen V. Worthington a, Gary J. Macfarlane c,*
a Turner Dental School, The University of Manchester, Manchester, UK Department of Public Health, University of Adelaide,Adelaide, South Australia, Australia c Unit of Chronic Disease Epidemiology, School of Epidemiology and Health Sciences, The University of Manchester, Oxford Road, Manchester M13 9PT, UK b

Received 8 November 2001; accepted 24 May 2002

Abstract Features of somatisation have been shown to predict the onset of widespread body pain. This study aims to determine to what extent persons with orofacialpain syndromes share these features and to what extent they are uniquely related to oral mechanical factors. We have conducted a population-based cross-sectional survey in the South-East Cheshire area of the United Kingdom involving 2504 individuals aged 18–65 years. All participants completed a postal questionnaire which enquired about the occurrence of both orofacial pain and widespread bodypain. It also enquired about potential risk factors for one or both conditions. In total, 473 subjects (23%) reported orofacial pain only, 123 (6%) widespread pain only, while 85 (4%) reported both. The number reporting both was significantly higher than would be expected if the symptoms were independent (P , 0:001). Several oral mechanical factors were significantly associated with both orofacialpain and widespread body pain (grinding teeth, clicking jaw, missing teeth), while two (facial trauma, locking jaw) were specifically related to orofacial pain. Both pain syndromes were associated equally with high levels of psychological distress, indicators of somatisation and maladaptive response to illness. These results suggest that orofacial pain syndromes may commonly be a manifestation of theprocess of somatisation and the excess reporting of some local mechanical factors amongst persons with these symptoms, may not be uniquely associated with pain in the orofacial region. q 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.
Keywords: Orofacial pain; Population-based survey; Widespread pain; Somatisation

1. IntroductionPain in the face or mouth (orofacial pain) is one of the most common regional pain syndromes. In the acute form, it is most commonly tooth-related or periodontal, but when chronic it is the hallmark symptom of clinical conditions such as temporomandibular disorders and atypical facial pain (LeResche, 2001). These chronic conditions commonly cause disability (Reisine, 1989) and frequently resultin attendance either to primary (dental or medical) care and onward referral to specialist services. (Lundeen et al., 1991). From studies examining the aetiology of chronic orofacial pain, several possible risk factors have been suggested. Firstly pain may arise as a result of local mechanical (injury) factors pertaining to the face or mouth and treatment can involve surgery, occlusal therapy orphysiotherapy to
* Corresponding author. Tel.: 144-161-275-5191; fax: 144-161-2755216. E-mail address: g.macfarlane@man.ac.uk (G.J. Macfarlane).

change these mechanical factors (Agerberg and Carlsson, 1972). In other cases, adverse psychological factors have been shown to be associated with chronic orofacial pain conditions (Drangsholt and LeResche, 1999; Zakrewska et al., 1999).Temporomandibular joint dysfunction and atypical facial pain have been postulated to be one of many functional somatic syndromes (Dworkin et al., 1994), which according to Wessely et al. are an ‘artefact of medical specialisation’ and a result of ‘the tendency of specialists to focus only on those symptoms pertinent to their specialty’ (Wessely et al., 1999). Widespread (musculoskeletal) body pain has been...