To determine the prevalence of facial pain and to examine the hypothesis that symptoms are associated with socio-demographic, dental, adverse psychological factors and pain elsewhere in the body.
Cross-sectional population data were obtained from UK Biobank (
The overall prevalence of facial pain (FP) was 1.9% (women 2.4%, men 1.2%) of which 48% was chronic. The highest prevalence was found in the 51 - 55 age group (2.2%) and the lowest in the 66 - 73 age group (1.4%). There was a difference in prevalence by ethnicity (0.8% and 2.7% in persons reporting themselves as Chinese and Mixed respectively). Prevalence of FP significantly associated with all measures of social class with the most deprived and on lowest income showing the highest prevalence (2.5% and 2.4% respectively). FP was more common in individuals who rated themselves as extremely unhappy, had history of depression and reported sleep problems. Smoking associated with increase in reporting FP while alcohol consumption had inverse association. FP associated with history of painful gums, toothache and all types of regional pain.
This is the largest ever study to provide estimates of facial pain prevalence. It demonstrates unique features (lower prevalence than previously reported) and common features (more common in women) and confirms multifactorial aetiology of facial pain. Significant association with psychological distress and a strong relationship to pain elsewhere in the body suggests that aetiology is not specific to this regional pain.
Facial pain (FP) is a common symptom experienced by a quarter of the adult UK population [
However a systematic review [
The very large sample size of the UK Biobank study gives an opportunity to provide the most precise estimates of FP prevalence and the relationship of multiple factors with the report of symptoms. It allows for thorough assessment of confounding factors and the sample allows the exploration of interactions.
The purpose of the study was to determine the prevalence of FP in UK Biobank study and to examine the hypothesis that symptoms are associated with socio-demographic, dental, adverse psychological factors and pain elsewhere in the body.
The study aimed to recruit persons aged 40 - 69 years who were registered with general medical practitioner within the UK National Health Service (NHS). As it is estimated that over 95% of persons are so registered, this provides a suitable population sampling frame in the United Kingdom. Overall about 9.2 million invitations were issued to people living within about 25 miles of one of the 22 assessment centres in England, Scotland and Wales. In total the study recruited 503,325 people between 2006 and 2010, a participation rate of 5.5%. Participants attended an assessment centre and completed questionnaires including items on lifestyle and environment.
The study has approval from the North West Multi-centre Research Ethics Committee. All participants gave informed consent. Detailed methods used by Biobank are described by Allen et al. [
Information on pain was collected by means of a touch screen questionnaire. Participants were asked “In the last month have you experienced any of the following that interfered with your usual activities?” They were then provided with a list: headache, facial pain, neck or shoulder pain, back pain, stomach or abdominal pain, hip pain, knee pain, pain all over the body. Participants were able to select more than one answer. For each site for which they answered positively, they were asked whether this pain had lasted at least three months, which we defined as chronic [
The determinants or exposures which we considered in relation to FP in this paper were demographic, socio-economic, psychological, sleep, behavioural factors and co-morbidities including dental factors.
Specifically, information was available on gender, age and ethnic group. Ethnic group is classified as white, mixed ethnic group, Asian or Asian British, black or black British, Chinese, or other ethnic group. Information was also available on average total household income, current employment status, highest qualification achieved and Townsend deprivation index [
Psychosocial factors we have used were self-defined happiness (In general how happy are you?) classified in six categories from extremely happy to extremely unhappy, work/job satisfaction (In general how satisfied are you with the WORK that you do?) classified in six categories from extremely happy to extremely unhappy, whether participants had ever been depressed for a whole week and the number of depressive episodes. Participants were also asked whether they had ever seen a general practitioner for “nerves, anxiety, tension or depression” and were asked about adverse life events such as illness, injury, bereavement or stress in the past 2 years.
Touchscreen question on sleep was “Do you have trouble falling asleep at night or do you wake up in the middle of the night?” (answer options were Never/rarely, sometimes or usually) and referred to the past 4 weeks. Snoring was defined as a positive answer to the touchscreen question “Does your partner or a close relative or friend complain about your snoring?”.
Participants were asked if they currently smoked and about their frequency of alcohol consumption (six point scale from daily or almost daily to never).
Participants rated their overall health in four categories as excellent, good, fair or poor. Questions on mouth and dental problems were related to the past year (mouth ulcers, painful gums, bleeding gums, loose teeth, toothache and dentures).
Prevalence rates of FP and other regional pains and of any chronic pain were calculated for respondents who had provided an answer to the pain question in the UK Biobank questionnaire. Directly standardised prevalence was calculated using UK population estimates in 2011 [
In total 500,488 (99.4%) participants in UK Biobank between 37 and 73 years old provided an answer for the question about pain they had experienced in the last month.
Of these 9,345 answered that they had FP, providing a crude prevalence of 1.87% (99% CI 1.82%, 1.92%) and directly standardised prevalence 1.89% (99 CI 1.83%, 1.94%), while 4,409 reported FP pain which was chronic, providing a prevalence of chronic FP of 0.88% (99% CI 0.85%, 0.92%) and directly standardised prevalence of FP 0.88% (99% CI 0.84%, 0.92%) (
Prevalence of facial pain by age, gender and ethnicity
Factor | N |
Facial pain |
Chronic facial pain |
||
---|---|---|---|---|---|
Prevalence |
RR (95% CI)c |
Prevalence |
RR (95% CI)c | ||
Crude (99% CI) | 1.87 (1.82, 1.92) | - | 0.88 (0.85, 0.92) | - | |
Adjusted (UK population) (99% CI) | 1.89 (1.83, 1.94) | - | 0.88 (0.84, 0.92) | - | |
|
|||||
37 - 45 | 64,143 | 2.09 | 1 | 0.97 | 1 |
46 - 50 | 67,409 | 2.2 | 1.04 (0.97, 1.21) | 1. | 1.02 (0.92, 1.13) |
51 - 55 | 78,609 | 2.22 | 1.04 (0.97, 1.12) | 1.06 | 1.07 (0.97, 1.19) |
56 - 60 | 98,013 | 1.87 | 0.89 (0.83, 0.95) | 0.9 | 0.92 (0.83, 1.02) |
61 - 65 | 118,811 | 1.61 | 0.77 (0.72, 0.83) | 0.76 | 0.78 (0.71, 0.87) |
66 - 73 | 73,503 | 1.4 | 0.68 (0.63, 0.74) | 0.66 | 0.7 (0.62, 0.79) |
|
|||||
Men | 228,150 | 1.22 | 1 | 0.53 | 1 |
Women | 272,338 | 2.41 | 1.95 (1.86, 2.04) | 1.18 | 2.21 (2.07, 2.36) |
|
|||||
37 - 45 | 29,417 | 1.44 | 1 | 0.55 | 1 |
46 - 50 | 29,747 | 1.48 | 1.03 (0.9, 1.17) | 0.62 | 1.13 (0.91, 1.39) |
51 - 55 | 34,013 | 1.54 | 1.07 (0.95, 1.22) | 0.68 | 1.23 (1, 1.5) |
56 - 60 | 43,450 | 1.22 | 0.85 (0.75, 0.97) | 0.54 | 0.97 (0.8, 1.19) |
61 - 65 | 55,163 | 1.03 | 0.72 (0.63, 0.81) | 0.45 | 0.82 (0.67, 0.99) |
66 - 73 | 36,360 | 0.84 | 0.58 (0.5, 0.67) | 0.4 | 0.72 (0.58, 0.91) |
|
|||||
37 - 45 | 34,726 | 2.65 | 1 | 1.33 | 1 |
46 - 50 | 37,662 | 2.78 | 1.05 (0.96, 1.15) | 1.31 | 0.98 (0.87, 1.12) |
51 - 55 | 44,596 | 2.73 | 1.03 (0.95, 1.12) | 1.35 | 1.02 (0.9, 1.15) |
56 - 60 | 54,563 | 2.39 | 0.9 (0.83, 0.98) | 1.2 | 0.9 (0.8, 1.02) |
61 - 65 | 63,648 | 2.11 | 0.8 (0.73, 0.87) | 1.03 | 0.77 (0.69, 0.87) |
66 - 73 | 37,143 | 1.94 | 0.73 (0.67, 0.81) | 0.92 | 0.69 (0.6, 0.8) |
|
|||||
White | 472,013 | 1.86 | 1 | 0.88 | 1 |
Mixed | 2,948 | 2.68 | 1.27 (1.02, 1.59) | 1.56 | 1.57 (1.17, 2.1) |
Asian or Asian British | 9,745 | 1.6 | 0.86 (0.73, 1.01) | 0.74 | 0.85 (0.67, 1.07) |
Black or Black British | 8,001 | 2.1 | 1.03 (0.88, 1.2) | 0.91 | 0.95 (0.75, 1.19) |
Chinese | 1,558 | 0.83 | 0.4 (0.23, 0.68) | 0.39 | 0.4 (0.17, 0.86) |
Other ethnic group | 4,507 | 1.91 | 0.95 (0.76, 1.17) | 0.8 | 0.96 (0.61, 1.17) |
No information | 1,716 |
aFacial pain that interfered with participants’ usual activities.
bChronic facial pain was defined as facial pains for more than 3 months. 132 participants did not answer the question about chronicity and were excluded.
cAdjusted for age group and gender.
RR = relative risks.
FP prevalence peaked at 51 - 55 years (2.22%) and then decreased with older age to 1.4% in age group 66 - 73 years (
In comparison to persons who identified their ethnicity as “white” (prevalence of FP 1.86%), persons identifying themselves as mixed ethnicity (2.68%, RR 1.27: 1.02, 1.59) were significantly more likely to report pain (
The prevalence of FP was strongly related to various measures of social and economic status. The prevalence of FP decreased monotonically as income group increased from 2.45% amongst those with annual incomes less than £18,000 to 1.2% amongst those with income greater than £100,000 (
Prevalence of facial pain by socio-economic factors
Factor | N |
Facial pain |
Chronic facial pain |
||
---|---|---|---|---|---|
Prevalence |
RR (95% CI)c |
Prevalence |
RR (95% CI)c | ||
|
|||||
< 18,000 | 96,895 | 2.45 | 1d | 1.25 | 1d |
18,000 - | 108,048 | 1.84 | 0.73 (0.68, 0.77) | 0.84 | 0.65 (0.6, 0.71) |
31,000 - | 110,715 | 1.68 | 0.62 (0.58, 0.66) | 0.76 | 0.55 (0.5, 0.6) |
52,000 - | 86,245 | 1.55 | 0.55 (0.51, 0.59) | 0.7 | 0.49 (0.44, 0.54) |
100,000 + | 22,930 | 1.2 | 0.43 (0.37, 0.48) | 0.54 | 0.38 (0.31, 0.46) |
No information | 75,655 | ||||
|
|||||
In paid employment or self-employed | 286,794 | 1.72 | 1 | 0.76 | 1 |
Retired | 166,592 | 1.69 | 1.27 (1.19, 1.35) | 0.82 | 1.44 (1.31, 1.58) |
Looking after home and/or family | 13,798 | 2.64 | 1.21 (1.09, 1.35) | 1.09 | 1.09 (0.93, 1.29) |
Unable to work because of sickness or disability | 16,734 | 5.12 | 3.18 (2.95, 3.42) | 3.18 | 4.51 (4.1, 4.96) |
Unemployed | 8,213 | 2.18 | 1.4 (1.21, 1.63) | 1.05 | 1.56 (1.25, 1.93) |
Doing unpaid or voluntary work | 2,313 | 2.68 | 1.5 (1.16, 1.92) | 1.12 | 1.41 (0.95, 2.07) |
Student | 1,337 | 2.69 | 1.35 (0.97, 1.87) | 1.2 | 1.33 (0.81, 2.18) |
No information | 4,707 | ||||
|
|||||
University or college degree | 161,028 | 1.71 | 1 | 0.8 | 1 |
A/AS level | 55,267 | 1.94 | 1.1 (1.02, 1.18) | 0.85 | 1.03 (0.92, 1.14) |
O level /GCSEs | 105,062 | 1.96 | 1.13 (1.06, 1.19) | 0.95 | 1.16 (1.08, 1.26) |
CSEs | 26,828 | 2.26 | 1.24 (1.13, 1.35) | 0.96 | 1.13 (0.98, 1.29) |
NVQ/HND/HNC | 32,661 | 1.83 | 1.23 (1.13, 1.35) | 0.84 | 1.24 (1.08, 1.41) |
Other professional qualifications | 25,765 | 1.78 | 1.08 (0.98, 1.19) | 0.9 | 1.15 (1.00, 1.33) |
None of the above | 84,877 | 1.89 | 1.24 (1.16, 1.32) | 0.95 | 1.34 (1.22, 1.47) |
No information | 9,000 | ||||
|
|||||
1 Least deprived | 49,812 | 1.62 | 1d | 0.68 | 1d |
2 | 50,139 | 1.65 | 1.02 (0.93, 1.12) | 0.74 | 1.11 (0.95, 1.28) |
3 | 49,975 | 1.71 | 1.06 (0.96, 1.17) | 0.8 | 1.18 (1.02, 1.37) |
4 | 49,894 | 1.74 | 1.07 (0.97, 1.18) | 0.78 | 1.15 (0.99, 1.33) |
5 | 50,043 | 1.74 | 1.07 (0.97, 1.18) | 0.81 | 1.19 (1.03, 1.38) |
6 | 50,011 | 1.82 | 1.11 (1.01, 1.22) | 0.84 | 1.23 (1.06, 1.42) |
7 | 50,011 | 1.94 | 1.18 (1.07, 1.29) | 0.93 | 1.35 (1.18, 1.56) |
8 | 49,987 | 1.87 | 1.13 (1.03, 1.24) | 0.96 | 1.4 (1.21, 1.6) |
9 | 49,981 | 2.16 | 1.31 (1.19, 1.43) | 1.05 | 1.53 (1.33, 1.75) |
10 Most deprived | 50,012 | 2.41 | 1.47 (1.35, 1.61) | 1.21 | 1.79 (1.57, 2.04) |
No information | 623 |
aFacial pain that interfered with participants’ usual activities.
bChronic facial pain was defined as facial pains for more than 3 months. 132 participants did not answer the question about chronicity and were excluded.
cAdjusted for age group and gender.
dTest for trend P < 0.001.
RR = relative risks.
The prevalence of FP was strongly related to various measures of psychological distress. Those who had consulted a GP for “nerves, anxiety, tension or depression” (3.02% v. 1.27%; RR 2.16: 2.08, 2.25) had an excess risk of reporting
FP and the likelihood of reporting FP increased strongly with the reported number of episodes of depression (No episodes: 0.93%; 1 episode: 1.37%, 2 - 3 episodes 1.75%; > 3 episodes 2.86%) (
The same relationship was found when respondents, who were employed, were asked about how satisfied they were with their job (extremely satisfied 1.17% to extremely dissatisfied 3.75% RR 3.11: 2.15, 4.48). Finally in relation to life events in the past two years, there was an increase in FP prevalence with number of adverse events (1.46% with 0 events, up to 5.09% for 3 or more events RR 3.16: 2.90, 3.44). Similar results were observed for chronic FP.
Prevalence of FP by psychological factors
Factor | N |
Facial pain |
Chronic facial pain |
||
---|---|---|---|---|---|
Prevalence (%) | RR (95% CI)c | Prevalence (%) | RR (95% CI)c | ||
|
|||||
Extremely happy | 9,236 | 0.95 | 1d | 0.37 | 1d |
Very happy | 65,186 | 1.13 | 1.14 (0.92, 1.43) | 0.55 | 1.43 (1, 2.03) |
Moderately happy | 88,421 | 1.74 | 1.72 (1.38, 2.13) | 0.86 | 2.17 (1.54, 3.06) |
Moderately unhappy | 6,449 | 3.02 | 3.01 (2.34, 3.87) | 1.61 | 4.15 (2.82, 6.12) |
Very unhappy | 1,278 | 4.54 | 4.48 (3.22, 6.25) | 2.9 | 7.44 (4.67, 11.87) |
Extremely unhappy | 400 | 6 | 6.12 (3.89, 9.61) | 4 | 10.64 (5.87, 19.3) |
No information | 329,518 | ||||
|
|||||
Extremely happy | 10,067 | 1.17 | 1 | 0.62 | 1 |
Very happy | 43,166 | 1.21 | 1 (0.82, 1.23) | 0.55 | 0.87 (0.66, 1.15) |
Moderately happy | 55,120 | 1.47 | 1.19 (0.98, 1.44) | 0.71 | 1.09 (0.83, 1.42) |
Moderately unhappy | 8,544 | 2.07 | 1.73 (1.37, 2.19) | 0.98 | 1.58 (1.14, 2.51) |
Very unhappy | 2,219 | 2.43 | 2.08 (1.5, 2.87) | 1.4 | 2.34 (1.51, 3.6) |
Extremely unhappy | 1,012 | 3.75 | 3.11 (2.15, 4.48) | 1.88 | 3.00 (1.79, 5.03) |
Not currently employed | 50,703 | 1.8 | 0.94 | ||
No information | 329,657 | ||||
|
|||||
No | 78,638 | 0.93 | 1 | 0.44 | 1 |
Yes | 89,256 | 2.09 | 2.05 (1.88, 2.23) | 1.05 | 2.16 (1.91, 2.44) |
No information | 332,594 | ||||
|
|||||
0 | 78,638 | 0.93 | 1d | 0.44 | 1d |
1 | 22,026 | 1.37 | 1.37 (1.29, 1.57) | 0.64 | 1.36 (1.12, 1.65) |
2 - 3 | 23,577 | 1.75 | 1.7 (1.5, 1.92) | 0.78 | 1.59 (1.33, 1.9) |
4+ | 18,637 | 2.86 | 2.81 (2.51, 3.15) | 1.51 | 3.1 (2.64, 3.63) |
No information | 357,610 | ||||
|
|||||
No | 327,541 | 1.27 | 1 | 0.56 | 1 |
Yes | 169,180 | 3.02 | 2.16 (2.08, 2.25) | 1.49 | 2.37 (2.23, 2.51) |
No information | 3,767 | ||||
|
|||||
0 | 271,981 | 1.46 | 1d | 0.66 | 1d |
1 | 162,418 | 1.99 | 1.32 (1.26, 1.38) | 0.93 | 1.37 (1.28, 1.47) |
2 | 47,353 | 2.89 | 1.85 (1.74, 1.97) | 1.41 | 2 (1.83, 2.18) |
3+ | 11,862 | 5.09 | 3.16 (2.9, 3.44) | 2.92 | 4.01 (3.57, 4.51) |
No information | 6,874 |
aFacial pain that interfered with participants’ usual activities.
bChronic facial pain was defined as facial pains for more than 3 months. 132 participants did not answer the question about chronicity and were excluded.
cAdjusted for age group and gender.
dTest for trend P < 0.001.
RR = relative risks.
Poor general health was associated with FP and chronic FP (RR 8.2; 95% CI 7.44, 9.03 and 15.29 95% CI 13.14, 17.79, respectively). Participants reporting sleep problems and snoring were more likely to report FP (RR 2.19; 95% CI 2.05, 2.33 and 1.23 95% CI 1.17, 1.28) and chronic FP (RR 2.59; 95% CI 2.37, 2.85 and 1.2 95% CI 1.13, 1.28) (
Prevalence of facial pain by sleep problems, smoking and alcohol consumption
Factor | N |
Facial pain |
Chronic facial pain |
||
---|---|---|---|---|---|
Prevalence (%) | RR (95% CI)c | Prevalence (%) | RR (95% CI)c | ||
|
|||||
Excellent | 81,835 | 0.74 | 1d | 0.26 | 1d |
Good | 288,592 | 1.5 | 2.06 (1.89, 2.24) | 0.61 | 2.41 (2.09, 2.78) |
Fair | 105,067 | 2.89 | 4.15 (3.8, 4.52) | 1.5 | 6.24 (5.4, 7.2) |
Poor | 22,714 | 5.68 | 8.20 (7.44, 9.03) | 3.64 | 15.29 (13.14, 17.79) |
No information | 2,280 | ||||
|
|||||
Never/rarely | 120,584 | 1.16 | 1d | 0.5 | 1d |
Sometimes | 238,351 | 1.73 | 1.42 (1.33, 1.51) | 0.75 | 1.44 (1.31, 1.58) |
Usually | 141,134 | 2.71 | 2.19 (2.05, 2.33) | 1.41 | 2.59 (2.37, 2.85) |
No information | 419 | ||||
|
|||||
No | 291,626 | 1.8 | 1 | 0.86 | 1 |
Yes | 173,100 | 1.91 | 1.23 (1.17, 1.28) | 0.88 | 1.20 (1.13, 1.28) |
No information | 35,762 | ||||
|
|||||
No | 447,389 | 1.81 | 1 | 0.85 | 1 |
Only occasionally | 13,700 | 1.9 | 1.11 (0.98, 1.25) | 0.8 | 1 (0.83, 1.22) |
Yes, on most or all days | 39,102 | 2.52 | 1.42 (1.33, 1.51) | 1.22 | 1.47 (1.34, 1.62) |
No information | 297 | ||||
|
|||||
Never | 40,409 | 2.74 | 1 | 1.53 | 1 |
Special occasions only | 57,805 | 2.63 | 0.92 (0.85, 0.99) | 1.34 | 0.84 (0.75, 0.93) |
One to three times a month | 55,767 | 2.33 | 0.83 (0.76, 0.9) | 1.11 | 0.71 (0.63, 0.79) |
Once or twice a week | 129,069 | 1.73 | 0.65 (0.61, 0.7) | 0.8 | 0.55 (0.49, 0.6) |
Three or four times a week | 115,325 | 1.49 | 0.58 (0.54, 0.63) | 0.63 | 0.45 (0.4, 0.5) |
Daily or almost daily | 101,691 | 1.42 | 0.59 (0.54, 0.63) | 0.62 | 0.47 (0.42, 0.52) |
No information | 422 |
aFacial pain that interfered with participants’ usual activities.
bChronic facial pain was defined as facial pains for more than 3 months. 132 participants did not answer the question about chronicity and were excluded.
cAdjusted for age group and gender.
dTest for trend P < 0.001.
RR = relative risks.
Smoking was associated with an increased risk of FP (RR 1.4 95% CI 1.33, 1.51) while alcohol had a protective effect (RR 0.59 95% CI 0.54, 0.63) for those who consumed alcohol daily or almost daily compared to never drinkers (
FP was more common in individuals with history in the past year of mouth ulcers (2.01 95% CI 1.90, 2.11), painful gums (4.27 95% CI 4.01, 4.54), bleeding gums (1.45 95% CI 1.37, 1.52), loose teeth (1.63 95% CI 1.5, 1.77), toothache (4.24 95% CI 4.01, 4.48) and those wearing dentures (1.15 95% CI 1.08, 1.21) (
Prevalence of facial pain by dental factors
Factor | N |
Facial pain |
Chronic facial pain |
||
---|---|---|---|---|---|
Prevalence (%) | RR (95% CI)c | Prevalence (%) | RR (95% CI)c | ||
|
|||||
No | 445,154 | 1.68 | 1 | 0.78 | 1 |
Yes | 50,183 | 3.51 | 2.01 (1.9, 2.11) | 1.76 | 2.15 (2, 2.32) |
No information | 5,151 | ||||
|
|||||
No | 480,133 | 1.68 | 1 | 0.79 | 1 |
Yes | 15,204 | 7.62 | 4.27 (4.01, 4.54) | 3.89 | 4.62 (4.24, 5.04) |
No information | 5,151 | ||||
|
|||||
No | 429,060 | 1.73 | 1 | 0.82 | 1 |
Yes | 66,277 | 2.74 | 1.45 (1.37, 1.52) | 1.27 | 1.4 (1.30, 1.51) |
No information | 5,151 | ||||
|
|||||
No | 473,694 | 1.82 | 1 | 0.86 | 1 |
Yes | 21,643 | 2.86 | 1.63 (1.5, 1.77) | 1.28 | 1.54 (1.37, 1.74) |
No information | 5,151 | ||||
|
|||||
No | 473,171 | 1.63 | 1 | 0.77 | 1 |
Yes | 22,166 | 6.88 | 4.24 (4.01, 4.48) | 3.22 | 4.22 (3.89, 4.58) |
No information | 5,151 | ||||
|
|||||
No | 412,333 | 1.87 | 1 | 0.88 | 1 |
Yes | 83,004 | 1.86 | 1.15 (1.08, 1.21) | 0.9 | 1.17 (1.08, 1.27) |
No information | 5,151 |
aFacial pain that interfered with participants’ usual activities.
bChronic facial pain was defined as facial pains for more than 3 months. 132 participants did not answer the question about chronicity and were excluded.
cAdjusted for age group and gender.
RR = relative risks.
Reporting of FP was particularly associated with headache (RR 6.01, 95% CI 5.76, 6.27), but was also significantly related to all other types of pain (
Prevalence of facial pain by other types of pain
Factor | N |
Facial pain |
Chronic facial pain |
||
---|---|---|---|---|---|
Prevalence (%) | RR (95% CI)c | Prevalence (%) | RR (95% CI)c | ||
|
|||||
No | 397,478 | 0.89 | 1 | 0.38 | 1 |
Yes | 103,010 | 5.64 | 6.01 (5.76, 6.27) | 2.8 | 6.87 (6.45, 7.32) |
|
|||||
No | 383,447 | 1.18 | 1 | 0.5 | 1 |
Yes | 117,041 | 4.1 | 3.39 (3.25, 3.53) | 2.12 | 4.12 (3.88, 4.37) |
|
|||||
No | 370,352 | 1.42 | 1 | 0.62 | 1 |
Yes | 130,136 | 3.13 | 2.23 (2.14, 2.32) | 1.62 | 2.67 (2.51, 2.83) |
|
|||||
No | 456,483 | 1.51 | 1 | 0.69 | 1 |
Yes | 44,005 | 5.55 | 3.44 (3.29, 3.61) | 2.91 | 3.97 (3.72, 4.24) |
|
|||||
No | 444,177 | 1.6 | 1 | 0.73 | 1 |
Yes | 56,311 | 3.97 | 2.44 (2.33, 2.56) | 2.1 | 2.82 (2.64, 3.02) |
|
|||||
No | 392,192 | 1.55 | 1 | 0.7 | 1 |
Yes | 108,164 | 3.02 | 2.03 (1.94, 2.11) | 1.55 | 2.31 (2.17, 2.45) |
aFacial pain that interfered with participants’ usual activities.
bChronic facial pain was defined as facial pains for more than 3 months. 132 participants did not answer the question about chronicity and were excluded.
cAdjusted for age group and gender.
RR = relative risks.
The final multivariate model for FP included 16 variables which were associated with increased risk: age (51 - 55 years), female gender, ethnicity (white or mixed), employment (retired, unable to work, doing unpaid work or student), adverse life events
(2 or more), mouth ulcers, painful gums, toothache, headache, neck or shoulder pain, back pain, stomach pain, hip pain, knee pain, sleep problems, alcohol consumption (never) and general health (poor). Data for all the above variables were available for 480,967 participants.
Prevalence of facial pain by number of factors from the final multivariate model
Number of factors reported | Facial paine | Chronic facial painf | ||
---|---|---|---|---|
N | Prevalence (%) | N | Prevalence (%) | |
0 - 1 | 28,906 | 0.33 | 23,413 | 0.11 |
2 | 75,060 | 0.43 | 63,702 | 0.15 |
3 | 102,169 | 0.67 | 93,186 | 0.24 |
4 | 94,838 | 1.12 | 93,222 | 0.39 |
5 | 69,840 | 1.81 | 74,493 | 0.61 |
6 | 46,224 | 2.78 | 52,291 | 1.11 |
7 | 28,468 | 4.08 | 33,684 | 1.64 |
8 | 16,651 | 5.59 | 20,600 | 2.23 |
9 | 9,256 | 7.84 | 12,121 | 3.67 |
10 | 4,984 | 10.39 | 6,955 | 4.83 |
11 | 2,474 | 14.35 | 3,647 | 6.94 |
12 | 1,227 | 18.01 | 3,541 | 10.87 |
13+ | 870 | 27.47 |
eModel included: Age (51 - 55 years), female gender, ethnicity (white or mixed), employment (retired, unable to work, doing unpaid work or student), adverse life events (2 or more), mouth ulcers, painful gums, toothache, headache, neck or shoulder pain, back pain, stomach pain, hip pain, knee pain, sleep problems, alcohol consumption (never), general health (poor). Data were available for 480,967 participants.
fModel included: Age (51 - 55 years), female gender, ethnicity (white or mixed), employment (retired, unable to work, doing unpaid work or student), adverse life events (2 or more), mouth ulcers, painful gums, bleeding gums, toothache, denture, headache, neck or shoulder pain, back pain, stomach pain, hip pain, knee pain, sleep problems, alcohol consumption (never) and general health (poor). Data were available for 480,835 participants.
The final multivariate model for chronic FP included 19 variables: age (51 - 55 years), female gender, ethnicity (white or mixed), employment (retired, unable to work, doing unpaid work or student), adverse life events (2 or more), mouth ulcers, painful gums, bleeding gums, toothache, denture, headache, neck or shoulder pain, back pain, stomach pain, hip pain, knee pain, sleep problems, alcohol consumption (never) and general health (poor). Data were available for 482,663 participants.
UK Biobank study is the largest ever study to provide estimates of FP prevalence. It demonstrates unique features (lower prevalence than previously reported) and common features (more common in women) and confirms multifactorial aetiology of FP. Significant association with psychological distress and a strong relationship to pain elsewhere in the body suggests that aetiology is not specific to this regional pain.
However the participation rate in this study was low which can result in biased prevalence estimates. We have presented both crude and adjusted (UK population) figures for the prevalence which were not very different. Another aspect which may influenced the results is the fact that the main question on various types of pain did not permit to specify any additional type of pain for those who reported widespread body pain.
The lower prevalence of FP demonstrated in this study could have been due to the way the question on FP was asked. For example, in the study by Macfarlane et al. [
The UK Biobank study used questionnaire based on a review of questionnaires previously used in epidemiological studies which was conducted in order to identify appropriate questions to quantify exposures, and involved wide consultation with international experts in each area of interest [
The UK Biobank study can be assessed as of high quality using instrument for assessing the quality of prevalence studies [
Previous population studies have found a higher prevalence of FP symptoms among younger people [
We found higher prevalence of FP in women compared to men, similar to previous studies [
It is difficult to compare the findings between studies examining different facets of social status. Macfarlane et al. [
Our results show variation in prevalence by ethnicity with the lowest prevalence of FP among the Chinese. Lipton et al. [
Cross-sectional [
Both the cross-sectional and case-control studies noted above indicated a strong dose-response relationship with increasing total sleep disturbance score [
We found an increased risk of FP with smoking. Men who currently smoked cigarettes were at increased risk of reporting orofacial pain [
It is likely that people who reported smoking are those with a less healthy life style. It can also be suggested that people with high levels of psychological distress are more likely to smoke. People with the highest quartile of psychological distress score were more likely to smoke, and this was true for both men and women [
The reason for protective effect of alcohol is unclear. Recent study of self-reported alcohol consumption in 946 patients with fibromyalgia [
Our analysis showed an increase in risk of FP by dental factors. Participants in a cross-sectional study conducted in the UK were more likely to report orofacial pain if they had more than five teeth missing [
The reporting of other bodily pain, such as upper body, leg pain and back pain, was also influential in the reporting of orofacial pain [
This is the largest ever study to provide estimates of facial pain prevalence. It demonstrates unique features (lower prevalence than previously reported) and common features (more common in women) and confirms multifactorial aetiology of facial pain. Significant association with psychological distress and a strong relationship to pain elsewhere in the body suggests that aetiology is not specific to this regional pain.
This research has been conducted using the UK Biobank resource.
The authors report no conflicts of interest related to this study.