Characterization of facial pain associated with chronic rhinosinusitis using validated pain evaluation instruments

Abstract

Background: Prior investigations into facial pain associated with chronic rhinosinusitis (CRS) have yielded important results, but have yet to use pain-specific outcome measures. This study seeks to characterize facial pain associated with CRS using validated pain-specific instruments.

Methods: Adults with CRS were enrolled into a prospective, cross-sectional study along with control participants presenting with non-CRS diagnoses. Facial pain was characterized in both groups using the Brief Pain Inventory Short Form (BPI-SF) and the Short-Form McGill Pain Questionnaire (SF-MPQ). CRS-specific measures of disease were measured including the 22-item Sino-Nasal Outcome Test-22 (SNOT-22), nasal endoscopy, and computed tomography scoring.

Results: The patients comprised of CRS with nasal polyposis (CRSwNP; n = 25), CRS without nasal polyposis (CRSsNP; n = 30), and control participants (n = 8). Subjects with CRSwNP and CRSsNP were less likely to be pain free than controls (16.0%, 6.7%, and 62.5% respectively, p = 0.001) and carried greater burden of pain as measured by the BPI-SF and SF-MPQ than controls (p = 0.002 and p = 0.017, respectively). Pain in CRS was most commonly located around the eyes and characterized as "throbbing" and "aching." Nasal polyp status was not associated with differences in character, severity, or location of pain.

Conclusion: Subjects with CRS have a greater burden of facial pain relative to control subjects across several standardized pain measures. Further, facial pain in CRS significantly correlated to quality of life and CRS-specific disease severity measures. Study across larger cohorts using standardized pain measures is warranted to clarify the association of facial pain with CRS.

Trial registration: ClinicalTrials.gov NCT01332136.

Keywords: data collection; endoscopy; facial pain; outcome assessment; sinusitis.

Conflict of interest statement

Conflict of interest: Timothy L. Smith, Jess C. Mace, and Jeremiah A. Alt are supported by a grant from the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, Bethesda, MD (R01 DC005805; PI/PD: TL Smith). Public clinical trial registration (www.clinicaltrials.gov) ID# NCT01332136. Timothy L. Smith and Adam S. DeConde are consultants for IntersectENT, Inc (Menlo Park, CA) which is not affiliated with this investigation. Richard R. Orlandi is a consultant for Medtronic ENT (Jacksonville, FL) which is not affiliated with this research.

© 2015 ARS-AAOA, LLC.

Figures

Figure 1

Modified diagram for sinus-related facial and/or head pain. Yellow area, above right eye; Blue area, above left eye; Gray area, below right eye; Green area, below left eye; Red area, between eyes; Black area, top of head; Orange area, back of head; Brown area, right temple; Purple area, left temple.

Figure 2

Frequency and location of reported facial pain in study participants with chronic rhinosinusitis (n=55).