Factors Predicting Orofacial Pain Patient Satisfaction with Improvement

Aims: To determine psychosocial predictors of patients’ ratings of satisfaction with improvement and subjective pain relief. This study also examined the underlying components of patient satisfaction with improvement, as assessed at follow-up. Methods: The sample consisted of 107 chronic orofacial pain patients evaluated at a university-based orofacial pain clinic and referred for treatment with individualized treatment plans. Pain and psychosocial functioning were assessed with standard, reliable, validated self-report instruments administered at the initial evaluation. Follow-up data were collected via a telephone-administered structured interview 8 months after the initial evaluation. Regression methodology was used to determine prediction models for satisfaction with improvement and subjective pain relief. Patient ratings of the quality of the caregiver communication were used as a control variable in all analyses. Results: Quality of caregiver communication predicted approximately 10 to 14% of the variance in outcomes in all models. Greater initial use of cognitive coping strategies and reduced depression predicted higher ratings of satisfaction with improvement and increased pain relief. When concurrent relationships among variables at the follow-up were examined, greater subjective pain relief since the evaluation, lower current pain, and higher ratings of overall mood were significant predictors of patient satisfaction with improvement. Conclusion: This study is one of the first to report that the use of certain cognitive coping strategies is associated with positive outcome for patients suffering from orofacial pain. These findings underscore the importance of individual differences on behavioral and psychosocial parameters in the prediction of patients’ subjective evaluation of treatment outcome.

orofacial pain; patient satisfaction; treatment outcome; psychological adaptation; psychological distress

1. Corah NL, O’Shea RM, Pace LF, Seyrek SK. Development of a patient measure of satisfaction with the dentist: The Dental Visit Satisfaction Scale. J Behav Med 1984; 7(4):367–373.

2. Hall JA, Dornan MC. Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Soc Sci Med 1990;30(7):811–818.

3. Weiss GL. Patient satisfaction with primary medical care: Evaluation of sociodemographic and predispositional factors. Med Care 1988;26(4):383–392.

4. Deyo RA, Diehl AK, Rosenthal M. How many days of bed rest for acute low back pain? N Engl J Med 1986;315:1064–1070.

5. Kane RL, Maciejewski M, Finch M. The relationship of patient satisfaction with care and clinical outcomes. Med Care 1997;35(7):714–730.

6. McCracken LM, Klock A, Mingay DJ, Asbury JK, Sinclair DM. Assessment of satisfaction with treatment for chronic pain. J Pain Symptom Manage 1997;14(5):292–299.

7. Ley P. Satisfaction, compliance and communication. Br J Clin Psychol 1982;21:241–254.

8. Fitzpatrick RM, Hopkins AP, Harvard-Watts O. Social dimensions of healing: A longitudinal study of outcomes of medical management of headaches. Soc Sci Med 1983;17(8):501–510.

9. Bayley KB, London MR, Grunkemeier GL, Lansky DJ. Measuring the success of treatment in patient terms. Med Care 1995;33(4)(suppl):AS226–AS235.

10. Barnes D, Smith D, Gatchel RJ, Mayer TG. Psychosocio-economic predictors of treatment success/failure in chronic low-back patients. Spine 1989;14:427–430.

11. Wilson PM, Sullivan F, Hussein S, Smith GD. Examination of the effects of emotional disturbance and its detection on general practice patients’ satisfaction with the consultation. Br J Gen Pract 1995;45:304–309.

12. Rosselli VR, Santalucia CA, Woodward AB, Luecke RW. Patient satisfaction under managed care: What every financial manager should know. J Health Care Finance 1996;22(4):61–66.

13. Pichert JW, Miller CS, Hollo AH, Gauld-Jaeger J, Federspiel CF, Hickson GB. What health professionals can do to identify and resolve patient dissatisfaction. Jt Comm J Qual Improv 1998;24(6):303–312.

14. Roth RS, Horowitz K, Bachman JE. Chronic myofascial pain: Knowledge of diagnosis and satisfaction with treatment. Arch Phys Med Rehabil 1998;79:966–970.

15. American Pain Society Committee on Quality Assurance Standards. Quality assurance standards for relief of acute and cancer pain. In: Bond MR, Charlton JE, Woolf CJ (eds). Proceedings of the VI World Congress on Pain. Amsterdam: Elsevier, 1991:185–189.

16. Murray H, Locker D, Mock D, Tenenbaum H. Patient satisfaction with a consultation at a cranio-facial pain unit. Community Dent Health 1997;14(2):69–73.

17. Türp JC, Kowalski CJ, Stohler CS. Treatment-seeking patterns of facial pain patients: Many possibilities, limited satisfaction. J Orofac Pain 1998;12(1):61–66.

18. Melzack R. The McGill Pain Questionnaire: Major properties and scoring methods. Pain 1975;1:277–299.

19. Riley JL III, Robinson ME. The coping strategies questionnaire: Five factors or fiction? Clin J Pain 1997;13:156–162.

20. Robinson ME, Riley JL III, Myers CD, Geisser ME, Kvaal SA, Saia T, Keefe FJ. The coping strategies questionnaire: A large sample item level factor analysis. Clin J Pain 1997;13(1):43–49.

21. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.

22. Spielberger CD, Gorsuch R, Lushene R, Vagg P, Jacobs G. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologist Press, 1983.

23. Holzberg AD, Robinson ME, Geisser ME, Gremillion HA. The effects of depression and chronic pain on psychosocial and physical functioning. Clin J Pain 1996;12:118–125.

24. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23:345–356.

25. Ware JE, Sherbourne CD. The MOS 36-item Short Form Health Survey (SF-36) I. Conceptual framework and item selection. Med Care 1992;30(6):473–483.

26. Jensen MP, Turner JA, Romano JM, Karoly P. Coping with chronic pain: A critical review of the literature. Pain 1991;47:249–283.

27. Riley JL III, Robinson ME, Geisser ME. Empirical subgroups of the Coping Strategies Questionnaire—Revised: A multisample study. Clin J Pain 1999;15(2):111–116.

28. Keefe FJ, Kashikar-Zuck S, Robinson E, Salley A, Beaupre P, Caldwell D, et al. Pain coping strategies that predict patients’ and spouses’ ratingsof patients’ self-efficacy. Pain 1997;73(2):191–199.

29. Turner JA, Whitney C, Dworkin SF, Massoth D, Wilson

L. Do changes in patient beliefs and coping strategies predict temporomandibular disorder treatment outcomes?Clin J Pain 1995;11(3):177–188.

30. Oakley ME, McCreary CP, Clark GT, Holston S, Glover D, Kashima K. A cognitive-behavioral approach to temporomandibular dysfunction treatment failures: A controlled comparison. J Orofac Pain 1994;8(4):397–401.

31. Rudy TE, Turk DC, Kubinski JA, Hussein SZ. Differential treatment responses of TMD patients as a function of psychological characteristics. Pain 1995;61:103–112.

32. Turk DC, Rudy TE, Kubinski JA, Hussein SZ, Greco CM. Dysfunctional patients with temporomandibular disorders: Evaluating the efficacy of a tailored treatment protocol. J Consult Clin Psych 1996;64(1):139–146.

33. Riley JL III, Robinson ME, Wise EA, Campbell LC, Kashikar-Zuck S, Gremillion HA. Predicting treatment compliance following facial pain evaluation. J Craniomandib Pract 1999;17(1):9–15.

34. Brown FF, Robinson ME, Riley JL III, Gremillion HA. Pain severity, negative affect, and microstressors as predictors of life interference in TMD patients. Cranio 1996;14(1):63–70.

35. Banks SM, Kerns RD. Explaining high rates of depression in chronic pain: A diathesis-stress framework. Psychol Bull 1996;119(1):95–110.

36. Oakley ME, McCreary CP, Flack VF, Clark GT, Solberg WK, Pullinger AG. Dentists’ ability to detect psychological problems in patients with temporomandibular disorders and chronic pain. J Am Dent Assoc 1989;118:727–730.

37. LeResche L. Assessment of physical and behavioral outcomes of treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83(1):82–86.