Suicidal ideation among patients with facial pain disorders

Abstract Introduction: Facial pain can be severely debilitating. Although etiologies vary, facial pain commonly results in diminished quality of life and a pronounced psychosocial burden. Objectives: To determine whether severe facial pain is associated with a heightened risk of suicidal ideation. Methods: We performed a retrospective review of patients with facial pain disorders who, during a presurgical evaluation, completed the Columbia-Suicide Severity Rating Scale and Brief Pain Inventory-Facial (BPI-Facial) scale, which assess suicidal risk and the effect of facial pain on quality of life, respectively. To evaluate the independent association between components of the BPI-Facial scale and suicidal thoughts or behaviors, we constructed a series of multivariable logistic regression models. Further classification and k-means clustering techniques were used to predict individual instances of suicidal ideation and to group distinct phenotypes of facial pain, respectively. Results: We identified 181 patients with facial pain who met the inclusion criteria. The most common cause of facial pain was trigeminal neuralgia (78.5%). Within our cohort, 13.3% of patients reported some degree of suicidal ideation in the Columbia-Suicide Severity Rating Scale questionnaire, a rate approximately 3 times higher than the estimated prevalence in the general adult population. This heightened risk of suicide was associated with considerable pain-related impairments reported in the BPI-Facial scale across the following tested domains: pain intensity, interference in general activities, and interference in face-specific activities. Conclusion: Our results suggest that facial pain can have highly detrimental effects on patient well-being. Moreover, quantifying facial pain-related impairments may assist in developing targeted interventions and longitudinal screening for mitigating the heightened risk of suicide among those with facial pain disorders.