Background & Aims
Chronic primary orofacial can encompass subtypes of temporomandibular joint disorders (TMD), burning mouth syndrome (BMS) and persistent idiopathic facial pain. Patients with these disorders often undergo multiple invasive investigations and treatments in search for an underlying cause to explain symptoms (1).
The aim of the current investigation were to test the hypothesis that analysis of neuroimaging studies will show a common underlying mechanism for all diagnoses of chronic primary orofacial pain.
Methods
A systematic review adhering to PRISMA guidelines was undertaken. Neuroimaging studies pertaining to chronic primary orofacial pain diagnoses were included using a systematic search on Medline (OVID) and SCOPUS databases. Brain signatures reported in the studies were pooled according to subtypes of chronic primary orofacial pain and analysed for overlap.
Results
The search identified 13 studies which were eligible for inclusion and published since 1990. The diagnostic categories for chronic primary orofacial pain encompassed in the identified studies only included BMS and TMD. Frequently reported brain areas that showed overlap in TMD and BMS included: Cingulate Cortex (CC), Insula (INS), Pre-Frontal Cortex (PFC), Thalamus (Thal) and Primary Somatosensory Cortex (S1). There was substantial heterogeneity and inconsistency in reporting outcomes so a meta-analysis was not possible.
Conclusions
The shared brain regions identified in this review for TMD and BMS have known functions in pain processing, emotion and coping. In agreement with the International Classification of Diseases (ICD-11) definition of chronic primary orofacial pain, this review adds support for a biopsychosocial approach in managing these disorders (2). Limitations included inability to meta-analyse the data due to heterogeneity of included studies and inconsistency in reporting outcome data.
References
1. Peters, S., Goldthorpe, J., McElroy, C., King, E., Javidi, H., Tickle, M. and Aggarwal, V.R. (2015), Managing chronic orofacial pain: A qualitative study of patients’, doctors’, and dentists’ experiences. Br J Health Psychol, 20: 777-791. https://doi.org/10.1111/bjhp.12141
2. Aggarwal VR, Fu Y, Main CJ, Wu J. 2019. The effectiveness of self-management interventions in adults with chronic orofacial pain: A systematic review, Meta-analysis and Meta-regression. European Journal of Pain. 23(5), pp. 849-865
3. Lovell K, Richards D, Keeley P, Goldthorpe J, Aggarwal V: Self-Management of Chronic Oro-facial Pain including TMD. University of Leeds 2019. https://licensing.leeds.ac.uk/product/self-management-of-chronic-orofacial-pain-including-tmd
4. https://medicinehealth.leeds.ac.uk/faculty-/dir-record/research-projects/1764/improving-outcomes-for-chronic-orofacial-pain-including-temporomandibular-disorders-the-tmd-study
5. Aggarwal VR, Wu J, Fox F, Howdon D, Guthrie E, Mighell A. 2021. Implementation of biopsychosocial supported self-management for chronic primary oro-facial pain including temporomandibular disorders: A theory, person and evidence-based approach. Journal of Oral Rehabilitation. 48(10), pp. 1118-1128
Presenting Author
Vishal Aggarwal
Poster Authors
Topics
- Pain Imaging