Orofacial Pain at a Tertiary Clinic: Comorbidities and Psychological Conditions Using the International Classification of Orofacial Pain (ICOP) Criteria.

Purpose: To characterize a patient group with refractory orofacial pain (OFP) at a tertiary pain clinic with emphasis on subtype distribution, comorbidities, sex differences and psychological factors. Patients and Methods: This retrospective study reviewed 98 consecutive patients assessed at the National Unit of Orofacial Pain, Haukeland University Hospital, Bergen, Norway (2017-2021). All patients were investigated by an interdisciplinary team that used a structured clinical interview and assessments and patients completed a series of standardized questionnaires that formed the basis for the final diagnosis and treatment plan. The International Classification of Orofacial Pain (ICOP-2020) was launched later and therefore retrospectively used forming the basis for this study. Five primary subtypes were analyzed: primary myofascial orofacial pain (pMOP), post-traumatic trigeminal neuropathic pain (PTTNP), persistent idiopathic facial pain (PIFP), trigeminal neuralgia (TN) and burning mouth syndrome (BMS). Secondary MOP (sMOP) was recorded when myalgia co-occurred with another primary diagnosis. Descriptive statistics, Results: The most frequent diagnosis was pMOP (60.2%), followed by PTTNP (20.4%), PIFP (14.3%), TN (4.1%), and BMS (3.1%). Twenty-five patients had more than one diagnosis Conclusion: Refractory OFP is dominated by pMOP and female patients. The strong association between PTTNP and sMOP suggests early combined management of neuropathic- and muscle pain which may limit chronification. Together, our findings support a personalized, interdisciplinary approach to OFP that can improve diagnostic precision and optimize long-term patient outcomes.