Psychopharmacological management and early symptom improvement in chronic oral pain: treatment patterns and outcomes after integrated psychiatric care

Introduction: Chronic oral pain syndromes frequently overlap with anxiety, depression, insomnia, and somatic distress, but psychiatric burden and psychopharmacological treatment patterns in oral pathology practice remain insufficiently described. This study aimed to characterize patients requiring psychiatric assessment or treatment in an oral pathology clinic and to explore short-term changes in pain and psychological symptoms after treatment modification. Methods: We conducted a retrospective, single-center observational pilot study based on routine clinical data. The analysis focused on patients undergoing psychiatric evaluation and/or psychopharmacological treatment. Continuous variables were summarized as median and interquartile range (IQR),and categorical variables as counts and percentages. The primary endpoint was change in oral pain intensity, measured with the visual analogue scale (VAS), from baseline (T0) to first follow-up (T1). Paired changes were assessed using Wilcoxon signed-ranktests; mean paired changes with 95% confidence intervals (CIs) were also reported. Secondary outcomes included PHQ-9, insomnia score, and GAD-7. Later follow-ups (T2 and T3) were exploratory. Clinically meaningful pain improvement was defined as a VAS reduction of at least 2 points at T1. Results: Seventeen patients were included. Median age was 69 years (IQR 58–74), and 11/17(64.7%) were female. Anxiety-related disorders were the most frequent diagnostic group (12/17,70.6%), followed by depressive disorders (4/17, 23.5%) and obsessive-compulsive disorder (1/17,5.9%). Medical comorbidity was present in 14/17 patients (82.4%). Baseline symptom burden washigh: median VAS was 8 (IQR 7–8), PHQ-9 10 (IQR 9–15), insomnia score 10 (IQR 8–14), andGAD-7 15 (IQR 13–16). SSRIs were the most frequently introduced or modified drug class (14/17,82.4%), with sertraline as the most common agent (13/17, 76.5%); melatonin was also frequently used (13/17, 76.5%). Among 13 patients with paired T0–T1 data, all outcomes improved. VAS decreased from 8 (IQR 7–8) to 5 (IQR 4–6), with a mean paired reduction of 2.38 points (95% CI1.75–3.02; Wilcoxon p=0.002). PHQ-9 decreased from 12 to 9, mean reduction 4.15 (95% CI2.88–5.43; p=0.002); insomnia score from 10 to 6, mean reduction 5.00 (95% CI 3.00–7.00;p=0.002); and GAD-7 from 15 to 10, mean reduction 4.38 (95% CI 2.91–5.86; p=0.002). Clinically meaningful pain reduction was observed in 10/13 paired cases (76.9%). Exploratory T2 and T3 analyses suggested persistent improvement. Conclusion: In this retrospective pilot sample, patients requiring psychiatric assessment ortreatment showed substantial psychiatric burden and medical comorbidity. Antidepressant-based management, especially SSRI use, predominated. Paired reductions in pain, anxiety, depressive symptoms, and insomnia were observed at first follow-up, with clinically meaningful pain improvement in about three quarters of paired cases. These preliminary findings support integrated psychiatric assessment in oral pathology settings. The frequent combined use of sertraline and melatonin may be consistent with a multimodal clinical approach targeting affective symptoms, sleep disturbance, and pain perception. No specific treatment effect can be inferred because of theretrospective design, small sample size, absence of a control group, and incomplete follow-up. Larger controlled studies are needed to clarify treatment trajectories.

References

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