Patient-Centered Outcome Criteria for Successful Treatment of Facial Pain and Fibromyalgia

Aims: To define treatment success from the facial pain and fibromyalgia pain patient perspective across four domains (pain, fatigue, emotional distress, interference with daily activities) through the use of the Patient-Centered Outcomes (PCO) Questionnaire. Methods: Participants included 53 facial pain (46 women, seven men) and 52 fibromyalgia (49 women, three men) patients who completed the PCO Questionnaire. The PCO assesses four relevant domains of chronic pain: pain, fatigue, distress, and interference in daily activities. Participants rated their usual levels, expected levels, levels they considered successful improvements, and how important improvements were in each of the four domains following treatment. Repeated-measures analyses of variance were performed to determine whether differences existed across domains and across pain groups. Results: Both groups of participants defined treatment success as a substantial decrease in their pain, fatigue, distress, and interference ratings (all approximately 60%). Fibromyalgia participants reported high levels of pain (mean = 7.08, SD = 2.04), fatigue (mean = 7.82, SD = 1.71), distress (mean = 6.35, SD = 2.46), and interference (mean = 7.35, SD = 2.21). Facial pain participants’ ratings of these domains were significantly lower for pain (mean = 5.62, SD = 2.38), fatigue (mean = 5.28, SD = 2.64), distress (mean = 4.34, SD = 2.78), and interference (mean = 4.10, SD = 3.06). Conclusion: These results demonstrate the high expectations of individuals with facial pain and fibromyalgia regarding treatment of their symptoms. Health care providers should incorporate these expectations into their treatment plans and discuss realistic treatment goals with their pain patients.

facial pain; fibromyalgia; patient-centered care; treatment outcome; pain/psychology

1. Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain 1998;77(3):231–239.

2. Rhodus NL, Fricton J, Carlson P, Messner R. Oral symptoms associated with fibromyalgia syndrome. J Rheumatol 2003;30(8):1841–1845.

3. Talley RL, Fricton JR, Okeson JP. Broad support evident for the emerging specialty of orofacial pain. J Okla Dent Assoc 2000;91(1):14–17.

4. Madland G, Newton-John T, Feinmann C. Chronic idiopathic orofacial pain: I: What is the evidence base? Br Dent J 2001;191(1):22–24.

5. Okeson JP. Nonodontogenic toothache. Tex Dent J Jul 2000;117(7):64–74.

6. Laine C, Davidoff F. Patient-centered medicine. A professional evolution. JAMA 1996;275(2):152–156.

7. Hirsh AT, Atchison JW, Berger JJ, et al. Patient satisfaction with treatment for chronic pain: predictors and relationship to compliance. Clin J Pain 2005;21(4):302–310.

8. Masi AT, White KP, Pilcher JJ. Person-centered approach to care, teaching, and research in fibromyalgia syndrome: justification from biopsychosocial perspectives in populations. Semin Arthritis Rheum 2002;32(2):71–93.

9. Alamo MM, Moral RR, Perula de Torres LA. Evaluation of a patient-centred approach in generalized musculoskeletal chronic pain/fibromyalgia patients in primary care. Patient Educ Couns 2002;48(1):23–31.

10. Brown JL, Edwards PS, Atchison JW, Lafayette-Lucey A, Wittmer V, Robinson ME. Defining patient-centered multidimensional success criteria for treatment of chronic spine pain. Pain Med 2008;9(7):851–62.

11. Newsome PR, McGrath C. Patient-centred measures in dental practice: 3. Patient satisfaction. Dent Update 2007;34(2):87–88, 90.

12. McGrath C, Newsome PR. Patient-centred measures in dental practice: 2. Quality of life. Dent Update 2007; 34(1):41–42, 44.

13. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33(2):160–172.

14. Robinson ME, Brown JL, George SZ, et al. Multidimensional success criteria and expectations for treatment of chronic pain: the patient perspective. Pain Med 2005;6(5):336–345.

15. Casarett D, Karlawish J, Sankar P, Hirschman K, Asch DA. Designing pain research from the patient’s perspective: what trial end points are important to patients with chronic pain? Pain Med 2001;2(4):309–316.

16. Farrar JT, Young JP, Jr., LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 2001;94(2):149–158.

17. Wolfe F. Fibromyalgia. Rheum Dis Clin North Am 1990;16(3):681–698.

18. Staud R, Price DD, Robinson ME, Vierck CJ, Jr. Body pain area and pain-related negative affect predict clinical pain intensity in patients with fibromyalgia. J Pain 2004;5(6):338–343.

19. Riley JL, 3rd, Robinson ME, Geisser ME, Wittmer VT. Multivariate cluster analysis of the MMPI-2 in chronic low-back pain patients. Clin J Pain 1993;9(4):248–252.

20. Turner JA, Jensen MP, Warms CA, Cardenas DD. Blinding effectiveness and association of pretreatment expectations with pain improvement in a double-blind randomized controlled trial. Pain 2002;99(1-2):91–99.