Harrison, Sheelah Dawn; (1999) Management of chronic idiopathic facial pain. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis contains a review of the literature concerning chronic idiopathic facial pain (CIFP) its presentation, management and psychological aspects. A two part study is then described: i. Treatment uptake The aim of the study was to measure psychological and objective parameters in patients attending for treatment of CIFP and investigate their association with acceptance of treatment. An assessment of clinical and psychological factors was made in 848 patients; of those with CIFP (713), 46% of patients declined treatment, 28% opted for routine treatment (10% due to trial exclusion criteria) and 26% accepted treatment within the study. The only predictors of treatment uptake were pain severity (p<0.00l), presence of constant pain (p<0.05) and age and marital status (p<0.01). ii. Treatment outcome: A comparison of cognitive behavioural therapy alone and in conjunction with an antidepressant drug. This randomised placebo-controlled study aimed to assess the effectiveness of treatment of chronic idiopathic facial pain with either a) fluoxetine; b) placebo; c) fluoxetine and cognitive behavioural therapy (CBT) and d) placebo and CBT in a cohort of 181 patients, over a period of three months. Pain and psychological measures were made during the treatment phase and an additional nine month follow up. Three months treatment with fluoxetine alone or in combination with CBT improved measures of pain severity (p<0.005), distress (p<0.05) and interference (p<0.05). Control was improved in those patients receiving CBT (p<0.05). During the follow up period when trial drug therapy had ceased, these changes were not maintained. However the need for further medical therapy was less in the CBT group. The final pain score was predicted only by the initial pain severity scores (p<0.001) and the time in follow up (p<0.05).

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