facial pain resource, depression

Chronic Facial Pain and Depression

Let’s be honest. Living with chronic facial pain can be deeply depressing. If the pain isn’t enough to bring you down, the consequences of living a pained life might. From the fear that you’ll get hit in public where there’s no easy escape; to the isolation of spending entire seasons in your house avoiding the weather; to the hopeless feeling you get when you allow yourself to look into the future; to the grief you feel when you look into the past and see all of the things that you missed or have forgotten: these things and many others provide ample reason for a chronic facial pain patient to also have a diagnosis of depression.

We know this intuitively, but there is also science to bolster the chronic facial pain-depression connection. In October 2016, a study was conducted in China by the Beijing Municipal Administration of Hospitals to “…evaluate depression and anxiety in patients with trigeminal neuralgia (TN), [and] identify factors that predict their occurrence…”1 The researchers concluded, in part, that chronic pain is a major predictive factor for depression development.

The study was conducted on a population of patients with intractable trigeminal neuralgia who had undergone radiofrequency rhizotomy. The researchers found that approximately 3 out of 4 of these TN patients (72.5%) also had clinical depression. Not only that, the researchers observed that although sufferers of all forms of chronic pain are at higher risk for depression than the general population, TN sufferers were much more likely to have depression than those with other forms of chronic pain.

General Population

Chronic Pain Patients

Intractable TN Patients

Prevalence of Depression

2.2% 30-54% 72.50%

Science and common sense bear out the truth that these facial pain conditions are depressing. It should therefore follow that all chronic facial pain patients are referred for psychosocial intervention to manage and perhaps even prevent the clinical depression that will likely accompany the facial pain.

I would like to see a study on how often these sorts of referrals are actually made. In over a decade with a chronic facial pain diagnosis, I have never received a referral for psychiatric care prompted by my pain diagnosis.* Quite to the contrary, it has been my experience that the fact that I am under the care of a psychiatrist elicits skepticism of my pain. As if my taking an antidepressant and an occasional benzodiazepine for anxiety somehow negates my credibility as a pain patient. This study shows that chronic facial pain is predictive of depression, and I am unaware of any studies done that have concluded that chronic facial pain is predictive of hypochondria, so what is it that prompts this prejudice?

1. YuanZhang, Ling, Yuna, Liqiang, Baishan, Jianning, Jingjie, Jia-xiang. Percutaneous trigeminal ganglion radiofrequency thermocoagulation alleviates anxiety and depression disorders in patients with classic trigeminal neuralgia: A cohort studyMedicine: December 2016. Volume 95. Issue 49. p e5379

* This is not entirely true. Early on, I saw a neurologist who quickly determined that I couldn’t have a neurological problem because it wasn’t MS and because I passed his highly sophisticated touch-your-finger-to-your-nose neurological exam. Despite the fact that I presented with almost every diagnostic criterion for trigeminal neuralgia, he dismissed the possibility because at 33, I was “too young.” Also, I had a “history of depression” which, when said by certain physicians in certain settings means “not credible when complaining of pain.” He told me that there was nothing that he or anyone else could do for me and, as he walked out the door, suggested that what I really needed was a good psychiatrist. Does that count as a referral?