2013-10-14 15:23:59 -
Pain in Europe VIII – 8th EFIC Congress, 9 – 12 October 2013, Florence
During the Congress of the European Pain Federation EFIC in Florence, pain experts today launched the „European Year Against Orofacial Pain“ which is dedicated to bringing more attention to an underestimated health problem. From October 2013 to October 2014, the campaign will highlight issues related to a broad range of pain symptoms which are felt in the mouth, jaws and the face.
Florence, 10 October 2013 – “Although acute pain is often well treated, chronic pain is often neglected and unrelieved and the social cost is huge. Across the EU, chronic pain accounts for 500 million lost working days, costing the European economies more than 34 billion euros
per year. However, only 2% of patients see an appropriate specialist trained in chronic pain, and 33% remain without any treatment for their pain ”, according to Dr Chris Wells (Liverpool, UK), President Elect of the European Pain Federation EFIC.
During the organisation’s biennial Congress “Pain in Europe VIII” in Florence, EFIC launched today the European Year Against Pain (EYAP) 2013 to 2014. “With this campaign, coordinated with the International Association for the Study of Pain, we devote an entire year to providing multifaceted information on one specific form of pain or particular issue related to pain”, Dr Wells said. “The EAYP initiative aims at presenting pain in all its aspects and social consequences, at supporting pain sufferers and at informing the general public. But it is also meant to raise awareness among policy makers to prioritise the major challenge chronic pain poses to health systems.”
Orofacial pain, an underestimated problem
This European Year Against Orofacial Pain from October 2013 to October 2014 focusses on a type of pain that many people have already experienced in its acute form, but that is largely underestimated in its chronic form.
“Orofacial pain is a general term covering any pain which is felt in the mouth, jaws and the face, with a broad range of possible causes and symptoms”, Dr Wells explained. “This goes far beyond toothache, which nearly everybody has experienced at some point, including burdening chronic conditions such as jaw pain, burning mouth syndrome, trigeminal neuralgia or cluster headache. Chronic orofacial pain is a major health problem throughout the world. 7% of the population have chronic facial pain, persisting for more than three months.”
An important proportion of cases of acute orofacial pain results from dental causes. “Nearly everybody has had toothache at some time,” Dr Wells said. “Figures show that one in nine people have had toothache-like pain from some cause in the last month.” This may be the reason why orofacial pain is a specialty in dentistry in some countries, according to Dr Wells: “Specialists have to diagnose the common causes of toothache such as dental caries, infection and tooth abscesses, as well as the rarer but often chronic pains that can manifest as toothache or facial pain.”
After dental pain, the second most common cause of orofacial pain is jaw pain (temporomandibular disorders, TMD), with an estimated prevalence of 5 to 10%. TMD alone costs $4 billion a year in the USA.
Another example of chronic facial pain that is difficult to treat is burning mouth syndrome (BMS) which affects up to 1 in 100 people. “Once thought to be a psychological problem, cutting edge research has shown that different types of dysfunctions, including nerve damage, are major factors, and complex medicine regimes can help,” Dr Wells explained.
“Two of the worst sorts of pain are trigeminal neuralgia (TGN), and cluster headache (CH) or migrainous neuralgia,” the expert added. “Both are so severe that they can drive the sufferer to suicide.” TGN is an agonising condition, with severe shooting pain coming from light touch, wind on the face, or chewing. Attacks last for seconds or minutes, but can occur up to 70 times a day. “The condition can occur in one in three hundred people, usually in older people,” Dr Wells explained. “It only responds to special types of painkillers that affect nerve pain, such as carbamazepine or pregabalin. Research shows it is caused by a blood vessel in the brain pressing on a nerve. Oral surgery only makes things worse, but pain clinic and neurosurgical techniques, such as burning or freezing the nerve, or delicate brain surgery, can relieve the pain.“
Cluster headache (CH) occurs in young people, especially men, and during attacks some victims describe a feeling of a red hot poker being pushed into the face. The nose runs and the eye goes red, and attacks come in clusters, lasting for up to two months at a time. Dr Wells: “Unfortunately, treatment is ineffective in some patients.”
Orofacial chronic pain conditions can present diagnostic and management challenges to the clinician, according to Dr Wells. “Sometimes there are special treatments for these types of pain that can be delivered by specialist clinics; sometimes there is no specific treatment, but useful support can be offered with integrated management by dentists, pain clinicians and psychologists. This takes into account all the different factors building up the pain, including stress.”
This European Year Against Orofacial Pain aims to tell the public about these different types of orofacial pain, about the possibilities of treatment and to encourage them to seek appropriate help, Dr Wells underlined. “EFIC believes that better diagnosis, treatment and prevention of oral and cranio-facial pains will significantly improve the quality of life of patients and have a considerable socioeconomic impact. “
EFIC makes available fact sheets and patient information leaflets on different types of orofacial pain at www.efic.org. The campaign will be backed up by a broad variety of initiatives in the 36 countries covered by EFIC.
Orofacial pain at the EFIC Congress
Also at the EFIC Congress in Florence, a number of sessions are devoted to orofacial pain, discussing, inter alia, new assessment techniques for better diagnosis of orofacial pain, or emerging insights in the molecular mechanisms involved in some of the chronic facial pain conditions. Studies presented at the EFIC Congress underline, inter alia, the importance of considering psychological factors such as catastrophising and kinesiophobia in the assessment and treatment of orofacial pain (EFIC Abstract Martinez et al). A UK population-based study (EFIC Abstract Macfarlane et al) shows that facial pain is often associated with psychological distress and widespread body pain, and is significantly related to pain elsewhere in the body.
From EWAP to EYAP
In 2001, EFIC launched the European Week Against Pain (EWAP) at the European Parliament. Each year since then, EFIC's national and regional chapters have held activities to sensitise stakeholders, the medical community and the general public about the issue of chronic pain. EWAP themes included cancer pain, headache, fibromyalgia and backache. From 2012 onwards, the event has been run together with IASP and been transformed into the "European Year Against Pain" (EYAP).
Sources: EFIC Abstract Martinez et al: Correlation among pain, disability and psychosocial factors in patients with chronic migraine, orofacial pain and craniomandibular disorders; EFIC Abstract Macfarlane et al: Self-reported facial pain in a national UK study.
EFIC Press Office:
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Dr Birgit Kofler
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Ph. after the Congress: +43-1-319 43 78-13