Neurophysiological changes and chronic pain in cleft patients

The aim of this study was to evaluate if patients after orofacial cleft repair experience neurophysiological changes with consecutive chronic pain states after surgery. Patients (n = 48) with a repaired orofacial cleft (CLP) recruited in a support group took part in a survey including five questionnaires. They revealed pain states, described cleft situation and history, and epidemiological data. Patients' quality of life and psychological comorbidity after the surgical procedures were assessed with the Oral Health Impact Profile (OHIP), the Giessen Subjective Complaints List (GSCL) and the Hospital Anxiety and Depression Scale (HADS). Furthermore, psychosocial impairment was documented. 39 out of 48 subjects with CLP reported to have experienced pain during the last 6 months. Pain was proven to be already chronic for 36 persons. Locations of pain were the orofacial region, back and limbs. Neurophysiological perception to cold, warmth, pressure and touch were found to be inhomogeneous. Local disturbances of subjective sensitivity in hard and soft tissues in the operated region are suspicious for neuropathic disorders and peripheral and central sensitization. 16 participants also reported that during dental interventions higher doses of local analgesia were necessary to achieve a pain free condition. Overall participants with CLP demonstrated elevated levels for anxiety and depression. As a conclusion for daily routine, CLP patients are considered to be at a higher risk to develop chronic pain states. To avoid these, proper pain and psychological management must be performed from early childhood. Further clinical studies examining patients with neurophysiological diagnostic tools are needed.