The impact of chronic orofacial pain on health-related quality of life

Heli Forssell 1 , Kirsi Sipilä 2 , 3 , Tuija Teerijoki-Oksa 4 , Pekka Vartiainen 5 , Hannu Kautiainen 6 , 7 , Harri Sintonen 8  and Eija Kalso 5
  • 1 Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, FIN-21520 Turku, Finland
  • 2 Research Unit of Oral Health Sciences, University of Oulu, Box 5000, FIN-90014, University of Oulu, Finland
  • 3 Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Box 5000, FIN-90014, University of Oulu, Finland
  • 4 Department of Oral and Maxillofacial Diseases, Turku University Hospital, Lemminkäisenkatu 2, FIN-20520 Turku, Finland
  • 5 Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2A, FIN-00029 HUS, Finland
  • 6 Folkhälsan Research Center, Helsinki, Finland
  • 7 Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
  • 8 Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), FIN-00014 University of Helsinki, Finland
Heli Forssell
  • Corresponding author
  • Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, FIN-21520 Turku, Finland
  • Email
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Kirsi Sipilä
  • Research Unit of Oral Health Sciences, University of Oulu, Box 5000, FIN-90014, University of Oulu, Finland
  • Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Box 5000, FIN-90014, University of Oulu, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Tuija Teerijoki-Oksa
  • Department of Oral and Maxillofacial Diseases, Turku University Hospital, Lemminkäisenkatu 2, FIN-20520 Turku, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Pekka Vartiainen
  • Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2A, FIN-00029 HUS, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Hannu Kautiainen
  • Folkhälsan Research Center, Helsinki, Finland
  • Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
, Harri Sintonen
  • Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), FIN-00014 University of Helsinki, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar
and Eija Kalso
  • Pain Clinic, Division of Pain Medicine, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 2A, FIN-00029 HUS, Finland
  • Search for other articles:
  • degruyter.comGoogle Scholar

Abstract

Background and aims

Health-related quality of life (HRQoL) assessments have been widely used in pain medicine as they are able to reflect the subjective and multidimensional nature of chronic pain. Studies have shown a consistent impairment in HRQoL in different chronic pain conditions. However, it is not known whether HRQoL is impaired in chronic orofacial pain (OFP). The generic 15D HRQoL instrument has been shown to fare as well as or better than other generic HRQoL instruments in the study of chronic pain. The aim was to investigate HRQoL in patients with chronic OFP using the generic 15D HRQoL instrument. The validity of the instrument was tested by studying the association of the 15D data with pain interference.

Methods

One hundred fifty-one patients (mean age 50 years, SD 15 years, 119 females) were recruited from three tertiary facial pain clinics. HRQoL data of the participants were contrasted with that of an age- and gender- standardized sample of general population by comparing the mean 15D scores and profiles. The data for the general population came from the National Health 2011 Survey representing Finnish population aged 18 years and older. Pain interference was assessed using Brief Pain Inventory. Based on pain interference distribution the participants were divided into tertiles. Statistical comparison between patient and population HRQoL values were performed using Monte-Carlo-type simulations. Statistical significance for the hypothesis of linearity was evaluated by using generalized linear models.

Results

The mean 15D score of OFP patients (0.824, SD 0.113) was statistically significantly lower than that of the age- and gender-standardized general population (0.929, SD 0.019) (p < 0.001). The difference between the patients and the general population was also clinically important, i.e. over the minimum clinically important difference in the 15D score. All mean 15D dimension values were significantly lower compared with the general population values (p < 0.001 for all dimensions). The largest differences were seen in the dimensions of discomfort and symptoms (0.418, SD 0.222 vs. 0.816, SD 0.027), sleeping (0.693, SD 0.258 vs. 0.838, SD 0.029), and vitality (0.702, SD 0.221 vs. 0.884 SD 0.026). There was a statistically significant linear decrease in the 15D dimension values (p < 0.001) with increasing pain interference. The greatest differences were found on the dimensions of discomfort and symptoms, sleeping and vitality.

Conclusions

HRQoL is significantly impaired in patients with chronic OFP. A decrease in the 15D dimension values with increasing pain interference indicated convergent validity between 15D and pain interference.

Implications

The findings suggest that 15D is an appropriate instrument for use in the assessment of HRQoL in OFP patients. By showing the usefulness of the 15D, the present study may encourage further use of generic HRQoL assessments in the study of chronic OFP, and contribute e.g. to the implementation of HRQoL as one of the core outcome measures in future treatment studies on chronic OFP.

    • Supplementary material
  • [1]

    Macfarlane TV, Glenny A-M, Worthington HV. Systematic review of population based epidemiological studies on oro-facial pain. J Dent 2001;29:451–67.

    • Crossref
    • PubMed
    • Export Citation
  • [2]

    Sessle BJ. The societal, political, educational, scientific, and clinical context of orofacial pain. In: Sessle BJ, editor. Orofacial pain: recent advances in assessment, management, and understanding of mechanisms. Washington, DC: IASP Press, 2014:1–15.

    • Crossref
    • Export Citation
  • [3]

    Durham J, Shen J, Breckons M, Steele JG, Araujo-Soares V, Exley C, Vale L. Healthcare cost and impact of persistent orofacial pain: the DEEP study cohort. J Dent Res 2016;95:1147–54.

    • Crossref
    • PubMed
    • Export Citation
  • [4]

    Guyatt GH, Freeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993;118:622–9.

    • Crossref
    • PubMed
    • Export Citation
  • [5]

    Vetter TR. A primer on health-related quality of life in chronic pain medicine. Anesth Analg 2007;104:703–18.

    • Crossref
    • PubMed
    • Export Citation
  • [6]

    Bansback N, Harrison M, Brazier J, Davies L, Kopec J, Marra C, Symmons D, Anis A. Health state utility values: a description of their development and application for rheumatic diseases. Arthritis Rheum 2008;59:1018–26.

    • Crossref
    • PubMed
    • Export Citation
  • [7]

    Loyland B, Miaskowski C, Paul SM, Dahl E, Rustoen T. The relationship between chronic pain and health-related quality of life in long-term social assistance recipients in Norway. Qual Life Res 2010;19:1457–65.

    • Crossref
    • PubMed
    • Export Citation
  • [8]

    Vartiainen P, Heiskanen T, Sintonen H, Roine RP, Kalso E. Health-related quality of life and burden of disease in chronic pain measured with the 15D instrument. Pain 2016;157:2269–76.

    • Crossref
    • PubMed
    • Export Citation
  • [9]

    Durham J, Steele JG, Breckons M, Story W, Vale L. DEEP Study: does EQ-5D-5L measure the impacts of persistent oro-facial pain? J Oral Rehabil 2015;42:643–50.

    • Crossref
    • PubMed
    • Export Citation
  • [10]

    Schofield DJ. How should we measure the impact of chronic pain? Limitations of utility measurement using the EQ-5D and SF-6D. Pain 2014;155:1918–9.

    • Crossref
    • PubMed
    • Export Citation
  • [11]

    Sintonen H. The 15D-measure of health-related quality of life. I. Relability, validity and sensitivity of its health state descriptive system. National Centre for Health Program Evaluation. Working Paper 41. Melbourne1994.

  • [12]

    Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med 2001;33:328–36.

    • Crossref
    • PubMed
    • Export Citation
  • [13]

    Hawthorne G, Richardson J, Day NA. A comparison of the assesment of quality of life (AQoL) with four other generic utility instruments. Ann Med 2001;33:358–70.

    • Crossref
    • Export Citation
  • [14]

    Vartiainen P, Mäntyselkä P, Heiskanen T, Hagelberg N, Mustola S, Forssell H, Kautiainen H, Kalso E. Validation of EQ-5D and 15D in the assessment of health-related quality of life in chronic pain. Pain 2017;158:1577–85.

    • Crossref
    • PubMed
    • Export Citation
  • [15]

    Ohrbach R, Durham J, Fillingim R. Self-report assessment of orofacial pain and psychosocial status. In Sessle BJ, editor. Orofacial pain: recent advances in assessment, management, and understanding of mechanisms. Washington, DC: IASP Press, 2014:121–41.

  • [16]

    Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992;50:133–49.

    • Crossref
    • PubMed
    • Export Citation
  • [17]

    Manfredini D, Borella L, Favero L, Ferronato G, Guarda-Nardini L. Chronic pain severity and depression/somatization levels in TMD patients. Int J Prosthodont 2010;23:529–34.

    • PubMed
    • Export Citation
  • [18]

    Suvinen TI, Kemppainen P, Le Bell Y, Valjakka A, Vahlberg T, Forssell H. Research diagnostic criteria Axis II in screening and as a part of biopsychosocial subtyping of Finnish patients with tempromandibular disorder pain. J Orofac Pain 2013;27:314–24.

    • Crossref
    • Export Citation
  • [19]

    Kotiranta U, Suvinen T, Kauko T, Le Bell Y, Kemppainen P, Suni J, Forssell H. Subtyping patients with temporomandibular disorders in a primary health care setting on the basis of the research diagnostic criteria for temporomandibular disorders Axis II pain-related disability: a step toward tailored treatment planning? J Oral Facial Pain Headache 2015;29:126–34.

    • Crossref
    • Export Citation
  • [20]

    Kotiranta U, Forssell H, Kauppila T. Painful Temporomandibular Disorders (TMD) and comorbidities in primary care: associations with pain-related disability. Acta Odontol Scand 2019;77:22–7.

    • Crossref
    • Export Citation
  • [21]

    Moock J, Kohlmann T. Comparing preference-based quality-of-life measures: results from rehabilitation patients with musculoskeltal, cardiovascular or psychosomatic disorders. Qual Life Res 2008;17:485–95.

    • Crossref
    • Export Citation
  • [22]

    Richardson J, Iezzi A, Khan MA, Chen G, Maxwell A. Measuring the sensitivity and construct validity of 6 utility instruments in 7 disease areas. Med Decis Making 2016;36:147–59.

    • Crossref
    • PubMed
    • Export Citation
  • [23]

    Alanne S, Roine RP, Räsänen P, Vainiola T, Sintonen H. Estimating the minimum important change in the 15D scores. Qual Life Res 2015;24:599–606.

    • Crossref
    • PubMed
    • Export Citation
  • [24]

    Tan G, Jensen MP, Thornby JI, Shanti BF. Validation of the Brief Pain Inventory for chronic nonmalignant pain. J Pain 2004;5:133–37.

    • Crossref
    • PubMed
    • Export Citation
  • [25]

    McCracken LM. Pain Anxiety Symptom Scale (PASS) and Short Version PASS-20. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine. New York, NY: Springer, New York, 2013:1423–4. Available at: http://dx.doi.org/10.1007/978-1-4419-1005-9_907.

    • Crossref
    • Export Citation
  • [26]

    Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of Beck Depression Inventories –IA and –II in Psychiatric Outpatients. J Pers Assess 1996;67:588–97.

    • Crossref
    • PubMed
    • Export Citation
  • [27]

    Partinen M, Gislason T. Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res 1995;4:150–5.

    • Crossref
    • PubMed
    • Export Citation
  • [28]

    Borodulin K, Vartiainen E, Peltonen M, Jousilahti P, Juolevi A, Laatikainen T, Mannisto S, Salomaa V, Sundvall J, Puska P. Forty-year trends in cardiovascular risk factors in Finland. Eur J Public Health 2015;25:539–46.

    • Crossref
    • PubMed
    • Export Citation
  • [29]

    Koskinen S, Lundqvist A, Ristiluoma N, editors. Health, functional capacity and welfare in Finland in 2011. National Institute for Health and Welfare (THL), Report 68/2012. Helsinki 2012. Available at: http://urn.fi/URN:ISBN:978-952-245-769-1.

  • [30]

    Phillip I. Good resampling methods: a practical guide to data analysis, Second ed. New York: Springer Science & Business Media, 2001.

  • [31]

    Saarni SI, Härkänen T, Sintonen H, Suvisaari J, Koskinen S, Aromaa A, Lönnqvist J. The impact of 29 chronic conditions on health-related quality of life: a general population survey in Finland using 15D and EQ-5D. Qual Life Res 2006;15:1403–14.

    • Crossref
    • PubMed
    • Export Citation
  • [32]

    Suominen K, Karlsson H, Rissanen A, Valtonen HM, Räsänen P, Sintonen H, Roine RP. Perceived burden of illness in patients entering for treatment in a university hospital – is the threshold to secondary care higher for patients with depression than for those with somatic disorders? Eur Psychol 2011;26:441–5.

    • Crossref
    • Export Citation
  • [33]

    Laas K, Roine R, Räsänen P, Sintonen H, Leirisalo-Repo M. HUS QoL Study Group. Health-related quality of life in patients with common rheumatic diseases referred to a university clinic. Rheumatol Int 2009;29:267–73.

    • Crossref
    • Export Citation
  • [34]

    Heiskanen T, Roine RP, Kalso E. Multidisciplinary pain treatment – Which patients do benefit? Scand J Pain 2012;3:201–7.

    • Crossref
    • PubMed
    • Export Citation
  • [35]

    Lobbezoo F, Vissher CM, Naeije M. Impaired health status, sleep disorders, and pain in the craniomandibular and cervical spinal regions. Eur J Pain 2004;8:23–30.

    • Crossref
    • PubMed
    • Export Citation
  • [36]

    Smith JG, Elias LA, Yilmaz Z, Barker S, Shah K, Renton T. The psychosocial and affective burden of posttraumatic neuropathy following injuries to the trigeminal nerve. J Orofac Pain 2013;27:293–303.

    • Crossref
    • PubMed
    • Export Citation
  • [37]

    Tjakkes GH, Reinders JJ, Tenvergert EM, Stegenga B. TMD pain: the effect on health related quality of life and the influence of pain duration. Health Qual Life Outcomes 2010;8:46.

    • Crossref
    • PubMed
    • Export Citation
  • [38]

    Lopez-Jornet P, Camacho-Alonso F, Lucero-Berdugo M. Quality of life in patients with burning mouth syndrome. J Oral Pathol Med 2008;37:389–94.

    • Crossref
    • PubMed
    • Export Citation
  • [39]

    Souza FTA, Santos TPM, Bernardes VF, Teixeira AL, Kummer AM, Silva TA, Abreu MHNG. The impact of burning mouth syndrome on health-related quality of life. Health Qual Life Outcomes 2011;9:57.

    • Crossref
    • PubMed
    • Export Citation
  • [40]

    Kim T-Y, Shin J-S, Lee J, Lee YJ, Kim M, Ahn Y Park KB, Hwang D-S, Ha I-H. Gender difference in associations between chronic temporomandibular disorders and general quality of life in koreans: a cross-sectional study. PLoS One 2015;10:e0145002.

    • Crossref
    • PubMed
    • Export Citation
  • [41]

    Tolle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 2006;6:153–60.

    • Crossref
    • PubMed
    • Export Citation
  • [42]

    Brazier J, Roberts J, Tsuchiya A, Busschbach J. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 2004;13:873–84.

    • Crossref
    • PubMed
    • Export Citation
  • [43]

    Dworkin RH, Turk DC, Farrar JT, Haythornthwaite JA, Jensen MP, Katz NP, Kerns RD, Stucki G, Allen RR, Bellamy N, Carr DB, Chandler J, Cowan P, Dionne R, Galer BS, Hertz S, Jadad AR, Kramer LD, Manning DC, Martin S, et al. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain 2005;113:9–19.

    • Crossref
    • PubMed
    • Export Citation
  • [44]

    Kaiser U, Kopkow C, Deckert S, Neustadt K, Jacobi L, Cameron P, De Angelis V, Apfelbacher C, Arnold B, Birch J, Bjarnegård A, Christiansen S, C de Williams A, Gossrau G, Heinks A, Huppe M, Kiers H, Kleinert U, Martelletti P, McCracken L, et al. Developing a core outcome domain set to assessing effectiveness of interdisciplinary multimodal pain therapy: the VAPAIN consensus statement on core outcome domains. Pain 2018;159:673–83.

    • Crossref
    • PubMed
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

Search