Patients who have long-term face and mouth pain that isn’t caused by toothache cost the British economy more than £3,000 each ($3,948) per year, according to researchers at Newcastle University, who also note that an electronic referral system can speed up diagnosis and treatment while improving the quality of life of these patients and save money.
These patients have more than £650 ($855.50) in out-of-pocket costs treating this pain each year, including prescription charges and travel expenses to and from appointments. Meanwhile, costs to employers can be almost £2,500 ($3,290) every 12 months due to worker absenteeism and loss of productivity.
The researchers asked 200 patients suffering from long-term face and/or mouth pain to complete questionnaires every six months for two years to assess how individuals used the National Health Service (NHS) for their pain.
The team collected the costs of the care the patients received, such as what the NHS paid to provide medication, surgery, or other treatment, how much patients paid out of their own pockets, and how their condition affected their ability to work.
With a six-month period, the participants reported an average of nine healthcare appointments, and those employed reporting missing almost two days of work. This absenteeism equates to an average employer cost of £174 per person per six months.
Despite the low numbers of days off of work, the subjects did report experiencing pain while working for nearly 35 days in a six-month period, during which they noted a decrease in their productivity while at work that could cost employers more than £1,000 each.
“We’re calling for the introduction of an electronic referral system that uses a graded chronic pain scale (GCPS): a simple seven-item questionnaire,” said Justin Durham, BDS, PhD, professor of orofacial pain and deputy dean of clinical medicine at Newcastle University and leader of the study.
“The scale would be a reliable way to determine who to fast-track to specialists and who should begin care immediately at their dentist or GP, meaning direct referrals would be made electronically to the best service local to the patient rather than relying on healthcare professionals’ knowledge of who manages persistent pain in their locality,” said Durham.
The researchers expect further research to focus on how care pathways can be designed to better meet the needs of patients. In partnership with the British Dental Association (BDA), they are helping dentists and GPs manage persistent facial pain by setting up study days for next year.
“Dentists working in hospitals will have seen patients who have failed to get priority, some on the verge of suicide in the face of unmanageable pain,” said Peter Dyer, chair of the BDA’s Central Committee for Hospital Dental Staff.
“This important research is a timely reminder that facial pain carries a huge personal and financial cost, and patients need not face barriers securing care,” Dyer said. “When so many people have been laid low by this condition, GPs and high street dentists need a clear pathway to ensure patients can get the right treatment when they need it.”
The researchers say their work adds weight to growing evidence that there is a need to screen patients with a GCPS to ensure those most severely affected receive specialist care quickly. Previously, the researchers showed that a well-established graded pain scale could help reduce costs by providing a better structured system of care.
“Our research shows that people have to go around the proverbial mulberry bush, visiting lots of different healthcare professionals to even get close to obtaining a diagnosis, never mind beginning treatment for their condition,” said Durham.
“A better and more defined care pathway would improve care for those with persistent facial pain and help reduce their costs and those to the economy,” said Durham.
The researchers say that 7% of the population has persistent orofacial pain, including temporomandibular disorders, phantom tooth pain, burning mouth syndrome, trigeminal neuralgia, and atypical facial pain. These patients attend many appointments with different professionals but fail to obtain an effective diagnosis or treatment plan quickly.
“Persistent facial pain is like having a toothache every day of the week and, therefore, understandably has a profound and debilitating impact on people’s lives, and our research has highlighted the hidden costs of this condition,” said Durham.
Joe Buckham, a 52-year-old father of two, began to experience severe facial pain a decade ago. The extraction of a wisdom tooth left the former teacher in agony as he suffered a fractured jaw during the procedure and a subsequent bone infection.
Despite extensive tests, scans, and investigations, healthcare professionals struggled to identify the problem. Buckham spent a lot of money on hospital visits, including up to eight train rides to a see a specialist, and private treatment such as acupuncture and sports massage therapy. Durham, however, successfully treated him at Newcastle upon Tyne Hospitals.
“I believe had I been given the correct treatment quicker than I was, then I would have continued to work as a teacher. Sadly, I had to retire because I couldn’t do the job due to the seriousness of the pain. Even things such as heat and antibiotics make it much worse,” Buckham said.
“The pain I get in my face is severe and it can be very debilitating. Sometimes it’s so bad, I just want to lie in a darkened room. Persistent facial pain is a hidden condition as no one can see the problem and people don’t understand it’s so serious that it can ruin lives and you’re stuck with it forever,” Buckham said.
“The specialist service in Newcastle is fantastic, and the research being done into facial pain is very much welcomed to help raise awareness of the condition,” Buckham said. “I feel that if medical healthcare professionals were able to use a graded chronic pain scale, it would help ensure patients like me got the best treatment as soon as possible.”
The study, “DEEP Study: Indirect and Out-of-Pocket Costs of Persistent Orofacial Pain,” was published by the Journal of Dental Research.