Diffusion model of pain language and quality of life in orofacial pain patients

Aims: To address the following questions: (1) Which words are preferred by different groups of orofacial pain patients to describe their pain experien ce (2) Is it possible, based on such descriptions, to obtain a clinical dif ferential diagnosis in these patients? (3) Is there any relationship betwee n the verbal description of pain and self-rated quality of life (QOL)? (4) Can a pattern of modulation of pain language by affective variables (diffus ion model) be recognized in orofacial pain patients, as is has in other chr onic pain patients and (5) If so, what might be the clinical usefulness of assessing pain language in these patients? Methods: A total of 332 consecut ive orofacial pain patients filled out an Italian Pain Questionnaire (the I talian analog of the McGill Pain Questionnaire) and were then divided into 6 diagnostic subgroups (sample 1) based on history and clinical findings. I n a double-blind setting, the distribution of pain descriptors and indexes was statistically evaluated. From sample 1, a randomly selected sample of 1 21 patients (sample 2) also filled out a QOL categorical scale. The results of both tests in this sample were compared statistically. Results: Some si gnificant differences among diagnostic subgroups were found for choice of d escriptors and for pain intensity. When a patient's pain description was co mpared to the corresponding self-evaluation of QOL, a self-perceived worsen ing of QOL revealed a good correlation with an increase in the number of wo rds chosen, pain intensity, and affective and sensory pain descriptors. A s imilar significant association was found between self-assessed anxiety and/ or depression and the same items. Conclusion: Although trends in patients' choice of descriptors were evident, differential diagnosis based on only a pain questionnaire was not possible in the different groups of orofacial pa in patients examined in this study. The present study suggests the presence of a phenomenon of diffusion in the language of those patients who were ex periencing a worsening of their QOL as a result of pain and consequent psyc hologic distress. This observation can be of clinical usefulness by enhanci ng the sensitivity of the clinician to the suffering and affective distress experienced by the patient, and it also can be helpful in refining the the rapeutic approach for each individual patient.