Chronic Pain Treatment Proves Difficult for Some Implant Patients

Dentistry Today


Though rare, chronic pain after dental implant surgery not only is possible, but it also can compromise the quality of life among those who suffer from it. Researchers from the Dental Institute at King’s College London recently examined 10 implant patients with severe chronic pain who attended the facility’s Orofacial Pain Clinic to better understand and improve treatment.

“Whilst we don’t want to worry people unduly, dentists should be aware that certain patients can be at greater risk of chronic post-surgical pain, particularly those with pre-existing chronic pain conditions elsewhere in the body,” said Dr. Maria Devine, lead author of the study.

The researchers say pain after implant surgery may be due to damage to nerves in the jaw, either directly from drilling during the procedure or indirectly from swelling or bleeding afterward. Chronic post-surgical pain does not respond to painkillers and is difficult to diagnose, as patients often have no abnormality that is visible or can be detected on scans.

According to the study, 9 of the 10 patients reported pain immediately after surgery, and half reported severe pain during surgery despite the use of anesthesia or painkillers. The patients also had experienced pain for an average of 3.4 years before attending the Orofacial Pain Clinic. Prior to attending the clinic, 2 patients had their implants removed, though their pain did not stop.

A pain management regime including prescription drugs, Botox injections, and/or cognitive behavioral therapy only achieved complete pain relief in one patient, while 5 had partial improvement and 3 experienced no improvement. Also, 6 had a medical history of conditions such as depression, anxiety, irritable bowel syndrome, peripheral neuropathic pain, and fibromyalgia.

Pain now is recognized as more than a physiological phenomenon. Psychological and social factors such as depression, anxiety, social stresses, and poor coping skills also are linked to the development of chronic pain. Neuropathic pain can be difficult to diagnose and treat, as it can arise without any detectable nerve injuries.

Drugs typically provide relief to only a proportion of patients with neuropathic pain. Management may include lidocaine plasters and Botox with further medication for those who don’t respond to initial treatments. Capasicum patches and creams may cause initial sensitivity and discomfort, followed by a longer period of pain reduction as receptors are “knocked out.” However, many patients find it difficult to wear a patch on their face and may only do so overnight.

The researchers noted that chronic pain following implant surgery is rare, so it is difficult to draw firm conclusions about risk factors and prognoses from the small group of patients they studied. They said that larger prospective studies are needed to better understand the mechanisms and extent of postsurgery chronic pain following dental implants.

“Patients should be appropriately screened for the risk of developing postsurgical pain during the treatment planning phase, particularly for elective surgery such as dental implants,” Devine said. “Chronic pain from dental surgery is a rare complication, highlighted in this small case series, but it is a condition increasingly recognized by the dental profession. More research is needed into this condition and its causes.”

“Chronic postsurgical pain, even after seemingly innocuous dental procedures, can result in long-term debilitating pain for a very small proportion of patients,” said professor Tara Renton of King’s College London Dental Institute, lead for orofacial pain services at the King’s College Hospital Foundation Trust, and author of the study.

“Dental practitioners need to be aware of permanent mouth pain as a possible complication of implant placement,” said Renton. “Every surgery has risks and benefits, and our study highlights that the consent process for dental procedures needs to include the rare possibility of long-term postsurgical pain.”

The study, “Chronic post-surgical pain following the placement of dental implants in the maxilla: A case series,” was published in the European Journal of Oral Implantology.

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