Journal of Pain Research (Nov 2020)
Challenges of Misdiagnosis and Suboptimal Treatment of Persistent Idiopathic Facial Pain and Atypical Odontalgia: A Retrospective Multi-Centric Cross-Sectional Investigation
Abstract
Xiong Xiao,1 Lei Jiang,2 Longjun Liu,3 Guoliang Chai,4 Fang Luo5 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Anesthesia, Beijing Fengtai Hospital, Beijing, People’s Republic of China; 3Department of Pain Management, Beijing Red Cross Peace Orthopedic Hospital, Beijing, People’s Republic of China; 4Imaging Department, Beijing Puhua International Hospital, Beijing, People’s Republic of China; 5Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Fang LuoDepartment of Pain Management, Beijing Tiantan Hospital, Capital Medical University, #119 West Road of the South Fourth Ring, Fengtai District, Beijing 100070, People’s Republic of ChinaTel +86 10 67096664Fax +86 10 67050177Email [email protected]: To explore the challenges faced in the diagnosis and treatment of atypical odontalgia (AO) and other persistent idiopathic facial pain (PIFP).Patients and Methods: This retrospective multi-centric cross-sectional study utilized clinical information (eg, clinical manifestations, history of consultations and treatments prior to correct diagnoses) from patients’ medical records. Their economic parameters were also extracted from medical insurance databases. Each variable collected was statistically analyzed. Differences of variables between AO and other PIFP were statistically tested.Results: A total of 394 patients were included in this study. On average, the diagnostic delay was 34.8± 14.2 months, a median of 7 consultations were performed prior to a correct diagnosis, and 5 ineffective prescriptions were issued. Patients with AO suffered from longer diagnostic delays than patients with other PIFP (38.4± 14.3 months vs 31.6± 13.4 months) and were more likely to receive invasive dental treatments (73.3% vs 4.3%). The median total cost of treatment for a single patient before correct diagnosis was 8506.3 yuan. Patients with AO spent more than patients with other PIFP (10,146.5 Yuan vs 3864.0 Yuan).Conclusion: Patients with PIFP were frequently misdiagnosed and the length of diagnostic delay was observed to be long. Ineffective medications, unwarranted procedures, and unnecessary economic burden were imposed on the patients. Patients with AO are in a worse situation than patients with other PIFP. As significantly urgent and unsatisfactory results of misdiagnosis of PIFP have been reported in our study, more attention should be paid on the research and education in this field.Keywords: persistent idiopathic facial pain, atypical odontalgia, misdiagnosis, suboptimal treatment, economic burden
