7-year follow-up of patients with persistent idiopathic dentoalveolar pain : preliminary results

Background: Persistent idiopathic facial pain (intraoral dentoalveolar subset), earlier described as atypical odontalgia (AO), is a chronic continuous dentoalveolar pain (CCDAP) condition commonly suggested to involve neuropathic pain mechanisms. The longterm prognosis of neuropathic pain conditions is generally not favorable, but has been insufficiently studied in intraoral pain patients. Aim: The aim of this prospective study was to examine the long-term prognosis of CCDAP (AO). Methods: We have earlier described the characteristics of 46 consecutive patients diagnosed with AO (List et al. 2007). Follow-up data on 27 of these patients have so far been collected and are included in this report. In 2002 and 2009, the patients completed validated questionnaires and instruments including pain and disability characteristics (pain frequency, characteristic pain intensity (CPI), average pain intensity (0-10 numerical rating scale, NRS) and graded chronic pain severity (GCPS)); psychological status (SCL-90 according to the RDC/TMD: depression and non-specific physical symptoms scores); ongoing treatment and a global improvement rating. Baseline and follow-up data were compared using paired samples t-test at 5 % significance level. Results: 23 women and 4 men were included (mean age 64, range 38-80 years). Pain frequency: 67% reported continuous pain at baseline and 33% at follow-up (p = .03). Occasional pain was reported by 0% at baseline compared to 19% at follow-up (p = .02). CPI scores (mean ± SD) decreased from baseline (59 ± 18) to follow-up (40 ± 25; p = .001). Also, average pain intensity decreased from baseline (5.6 ± 2.0) to follow-up (3.6 ± 2.5; p=.001). A >30 % pain reduction was seen for 24 % of the patients, 1-30 % pain reduction for 40 %, unchanged pain for 24 %, and 12 % reported increased pain. GCPS: Fewer patients scored Grade III-IV at follow-up (7.4 %) than at baseline (29.6 %; p=0.031). Grade 0 was 0% at baseline and 11.1 % at follow-up (p = .083). SCL-90 scores reported by the AO patients for depression at follow-up was: 39% severe, 26% moderate and 42% normal, and for non-specific physical symptoms 62% severe, 11% moderate and 27% normal with no significant differences between baseline and follow-up (p > .5). Global improvement: 54% rated their overall pain status as improved, 42% as unchanged and 4% as worse. Ongoing treatment was use of occlusal splints (41%); analgesics, tranquilizers and sedatives (all 22%); antidepressants (15%); physiotherapy (11%); and gabapentin or pregabalin (both 7%). Conclusions: The preliminary data suggest that a majority of CCDAP (AO) patients improve over time and experience pain reduction of some degree. Psychological status does not change accordingly, and a number of patients report unchanged or even increased pain. The objective of future analysis of this material will be to identify positive and negative predictors for persistent pain