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Mental Disorders Diagnosed in Half of Outpatients in Orofacial Pain Clinic

TO THE EDITOR: In a World Health Organization (WHO) cross-cultural study in primary care, the prevalence of somatoform disorders was reported to be 9%–37%.¹ Up to 40% of patients who complain of pain are diagnosed as having pain disorder.² To determine the prevalence of mental disorders, including somatoform disorder, in an orofacial pain clinic, we examined the prevalence of somatoform disorders and other mental disorders.

The subjects in this study were 120 outpatients who attended our orofacial pain clinic in Shizuoka Municipal Shimizu Hospital, Shizuoka, Japan, between June 1, 2003, and May 31, 2004. Ninety-nine patients were women, and 21 were men; ages ranged from 15 to 83 years (mean: 45.3, standard deviation [SD]: 16.7 years). Diagnosis and treatment were carried out by both an orofacial pain expert (a dentist) and a psychiatrist, working together, and mental disorders were diagnosed by use of DSM-IV-TR.³

Sixty patients (50.0%) were diagnosed as having somatic (organic) diseases; 28 (23.3%), temporomandibular dysfunction (TMD) syndrome; 14 (11.7%), primary headache; 9 (7.5%), paroxysmal neuralgia; 5 (4.2%), medication-overuse headache (MOH); and the remainder, various other general medical conditions. Sixty patients (50.0%) had mental disorders; 54 (45.0%), somatoform disorders; 2 (1.7%), major depressive disorder; 2 (1.7%), delusional disorder; and the remainder, various other mental disorders.

Forty-one patients (34.2%) were diagnosed as having pain disorder associated with psychological factors in the orofacial region. Patients with pain disorder associated with psychological factors in the orofacial region accounted for 75.9% of patients with somatoform disorders. Moreover, 26 of 41 patients with pain disorder associated with psychological factors had so-called atypical odontalgia (AO).

Half of the outpatients in the orofacial pain clinic were diagnosed as having various mental disorders. Furthermore, patients with pain disorder associated with both psychological factors and a general medical condition may be included in the category of patients with somatic (organic) diseases. About one-third of patients with orofacial pain were diagnosed as having pain disorder associated with psychological factors. The majority of patients with pain disorder associated with psychological factors had so-called AO, which fulfills the criteria of Pain Disorder Associated With Psychological Factors of DSM–IV–TR,³ even though one of the proposed mechanisms of AO is neural deafferentation.⁴ The high proportion of patients with somatoform disorders in the orofacial pain clinic is probably due to the remarkably high number of patients with pain disorder associated with psychological factors. To diagnose and treat patients with orofacial pain, medical doctors and dentists working in orofacial pain clinics should be careful not to underdiagnose mental disorders, especially somatoform disorders. Psychiatrists, who can prescribe antidepressants, should be consulted, because the first-line treatment of pain disorder is an SSRI or tricyclic antidepressant.⁵ To ensure correct diagnosis and treatment, more consulting psychiatrists are needed in orofacial pain clinics.

REFERENCES

1. Gureje O, Simon G: Somatization in cross-cultural perspective: a World Health Organization study in primary care. Am J Psychiatry 1997; 154:989–995[Abstract]
2. Kaplan HI, Sadock BJ (eds): Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences, 7th Edition. Baltimore, MD, Williams & Wilkins, 1994, p 618
3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders 4th Edition, Text Revision (DSM-IV-TR). Washington, DC, American Psychiatric Association, 2000, pp 498-503
4. Lilly JP, Law AS: Atypical odontalgia, atypical odontalgia misdiagnosed as odontogenic pain: a case report and discussion of treatment. J Endod 1997; 23:337–339[Medline]
5. Fishbain DA: Do antidepressants have an analgesic effect in psychogenic pain and somatoform pain disorder? a meta-analysis. Psychosom Med 1998; 60:503–509[Abstract/Free Full Text]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Ikawa, M. Articles by Yamada, K. Search for Related Content PubMed Citation Articles by Ikawa, M. Articles by Yamada, K. Primary Care Syndromes Secondary to General Medical Disorders

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