Chronic Orofacial Pain in Southern Chinese People: Experience, Associated Disability, and Help-Seeking Response

Aims: To investigate chronic orofacial pain experience, psychosocial impact, and help-seeking response in adult Chinese people in Hong Kong. Methods: A cross-sectional population-based telephone interview survey identified 1,352 randomly selected people aged ≥ 18 years. Standard questions were asked about current or episodic and prior (≥ 6 months) experience of 7 orofacial pain symptoms. Pain intensity and psychosocial impact were assessed through the Graded Chronic Pain Scale, and the help-seeking response was assessed using the 4-item Level of Expressed Need (LEN) measure. Results: Current or episodic symptoms of orofacial pain were reported by 57.0% of respondents, and 13.2% of this group reported symptoms that had lasted for ≥ 6 months (chronic subgroup). In the chronic subgroup, toothache was the most common symptom (42.2%) and oral sores the least common (7.8%). The mean pain intensity in the chronic pain subgroup was 46.6 (SD 21.7) with no age or gender differences (P > .05); 88.2%had low disability levels and 11.8% had high levels. 81.4% had low LEN scores and 18.6% had high scores, with no age/gender differences (P > .05). Conclusion: The prevalence of current/episodic orofacial pain was relatively high, whereas chronic orofacial pain was much less common. Although the intensity of chronic orofacial pain was significant, associated psychosocial disability was low, as was the level of perceived need for treatment. These findings may be related to more effective pain-coping strategies and greater acceptance of pain in this ethnic group compared to other ethnic groups.

Chinese; chronic pain; orofacial; prevalence; psychosocial; treatment-seeking

1. Zakrzewska JM, Hamlyn PJ. Facial pain. In: Crombie I (ed). Epidemiology of Pain. Seattle: IASP Press; 1999:171-201.

2. Locker D, Grushka M. Prevalence of oral and facial pain and discomfort: Preliminary results of a mail survey. Community Dent Oral Epidemiol 1987;15:169–172.

3. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Orofacial pain in the community: Prevalence and associated impact. Community Dent Oral Epidemiol 2002;30:52–60.

4. McMillan AS, Wong MCM, Zheng J, Lam CLK. Prevalence of orofacial pain and treatment seeking in Hong Kong Chinese. J Orofac Pain 2006;20:218–225.

5. Von Korff M, Dworkin SF, LeResche L, Kruger A. An epidemiologic comparison of pain complaints. Pain 1988;32: 173–183.

6. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992;50:133–149.

7. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Predictors of outcome for orofacial pain in the general population: A four-year follow-up study. J Dent Res 2004;83:712–717.

8. Chung JW, Kim JH, Kim HD, Kho HS, Kim YK, Chung SC. Chronic orofacial pain among Korean elders: Prevalence, and impact using the graded chronic pain scale. Pain 2004;112:164–170.

9. Macfarlane TV, Glenny AM, Worthington HV. Systematic review of population-based epidemiological studies of oro-facial pain. J Dent 2001;29:451–467.

10. Luo Y, McMillan AS, Wong MCM, Zheng J, Lam CLK. Orofacial pain conditions and impact on quality of life in community-dwelling elderly people in Hong Kong. J Orofac Pain 2007;21:63–71.

11. Macfarlane TV, Blinkhorn AS, Davies RM, Kincey J, Worthington HV. Factors associated with health care seeking behaviour for orofacial pain in the general population. Community Dent Health 2003;20:20–26.

12. Smith BH, Penny KI, Elliot AM, Chambers WA, Smith WC. The level of expressed need—A measure of help-seeking behaviour for chronic pain in the community. Eur J Pain 2001;5:257–266.

13. Ng JKF, Tsui SL, Chan WS. Prevalence of common chronic pain in Hong Kong adults. Clin J Pain 2002;18: 275–281.

14. 2006 Population By-Census: Summary results. Hong Kong: Census and Statistics Department, Government of the Hong Kong Special Administrative Region, 2007.

15. Locker D, Slade GD. Prevalence of symptoms associated with temporomandibular disorders in a Canadian population. Community Dent Oral Epidemiol 1988;16:310–313.

16. Riley JL III, Gilbert GH. Orofacial pain symptoms: An interaction between age and sex. Pain 2001;90:245–256.

17. Purves AM, Penny KI, Munro C, et al. Defining chronic pain for epidemiological research—Assessing a subjective definition. Pain Clinic 1998;10:139–147.

18. Goulet JP, Lavigne GJ, Lund JP. Jaw pain prevalence among French-speaking Canadians in Québec and related symptoms of temporomandibular disorders. J Dent Res 1995;74:1738–1744.

19. Riley JL III, Gilbert GH, Heft MW. Orofacial pain symptom prevalence: Selected sex differences in the elderly?Pain 1998;76:97–104.

20. Swanljung O, Rantanen T. Functional disorders of the masticatory system in southwest Finland. Community Dent Oral Epidemiol 1979;7:177–182.

21. Lam TH, Kleevens JWL, Wong CM. Doctor-consultation in Hong Kong: A comparison between finding of a telephone interview with the general household survey. Community Med 1988;10:175–179.

22. Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115–121.

23. Lee LTK, Yeung RWK, Wong MCM, McMillan AS. Diagnostic sub-types, psychological distress and psychological dysfunction in southern Chinese with temporomandibular disorders. J Oral Rehabil 2008;35:184–190.

24. List T, Dworkin SF. Comparing TMD diagnosis and clinical findings at Swedish and US TMD centers using Research Diagnostic Criteria for Temporomandibular Disorders. J Orofac Pain 1996;10:240–253.

25. Dworkin SF, Ohrbach R. Assessment of orofacial pain. In: Turk DC, Melzack R (eds). Handbook of Pain Assessment, ed 2. New York: The Guilford Press, 2001: 475–498.

26. Last JM. The iceberg: Completing the clinical picture in general practice. Lancet 1963;ii:28–31.

27. Locker D. The symptom iceberg in dentistry; treatment seeking in relation to oral and facial pain. J Can Dent Assoc 1988;54:271–274.

28. Riley JL III, Gilbert GH, Heft MW. Race/ethnic differences in health care use for orofacial pain among older adults. Pain 2002;100:119–130.

29. Schwarz E, Lo ECM. Oral health and dental care in Hong Kong. Int Dent J 1995;45:169–176.

30. Hastie BA, Riley JL, Fillingim RB. Ethnic differences and responses to pain in healthy young adults. Pain Med 2005;6:61–71.

31. Moore R, Brødsgaard I. Cross-cultural investigations of pain. In: Crombie I (ed). Epidemiology of Pain. Seattle: IASP, 1999:53–79.