Failure in chronic pain therapy across the disciplines

The purpose of this article is to review the pain literature in order to gain beneficial information from articles about thera- peutic failure among patients with chronic orofacial pain. A PubMed search (July 2017) yielded 17 relevant citations: most articles related to psychosocial aspects, pharmacological management, and surgical procedures. Neglect of psychosocial assessment may have disadvantageous consequences for diagnosis and therapy. Finding the right medication and dosage may be a challenge for therapists, while surgical interventions require a strict indication. Additional causes for therapeutic failure are an exclusive focus on somatic complaints, a strong emphasis on imaging, and ignorance of the principles of evidence-based medicine. The consequence of deficiencies in medical and dental education may be diagnostic and therapeutic arbitrariness, which is associated with an increased risk of failure. Patient-related factors for failure may be interindividual variation, somatic comorbidity, negative psychosocial influences, and lack of adherence to therapy. Keywords: chronic pain, diagnosis, evidence-based dentistry, medical education, PubMed, treatment failure