This qualitative, interview-based research study involved southern Chinese elders from the general population in Hong Kong who were suffering from different types of non-dental chronic OFP. The purpose of the qualitative approach is to contribute the conceptual and theoretical knowledge on particular issues can be learned from individual life experiences and perceptions .
According to previous quantitative research, OFP symptoms were found to have a significant detrimental effect on functional, psychosocial well-being, daily life activities and lowered the quality of life of the Chinese elders [15, 20, 25, 26]. However the majority of southern Chinese elderly people did not seek professional treatment for chronic OFP: only 27% with OFP symptoms sought professional treatment [15, 27]. The likelihood for treatment seeking for OFP increased with the number of days when OFP was experienced . However, in this study, we found that the participants who were suffering from chronic OFP were keen to consult health professionals in the hope of relieving the pain symptom. On the other hand, there were only a few of them who had never sought any professional treatment for the chronic OFP. The most likely reason for not seeking treatment was that the pain was relatively mild in nature and it did not have a great impact on their daily lives. They claimed that they could control the pain by their own coping strategies and they had already accepted/ adapted to the pain as part of their lives.
People with chronic OFP often have sought help from multiple health professionals for symptomatic pain relief. Because there is a lack of a “specialized chronic OFP clinic” in Hong Kong, we found that some of the participants did not know where and from whom they should seek treatment. Among the available choice of health professionals, most of them preferred to seek treatment from a physician rather than a dentist. This finding was in agreement with our previous finding [15, 27] and another study in the United Kingdom . The concepts of the clinical role of physician and dentist were usually determined by the patients’ experiences and perceptions as well as the influence from their family and peers . They regarded physicians as being better trained to diagnose and treat symptoms that are of non-dental origin . It is relevant that over half of the dental graduates from the University of Hong Kong felt that they were less well equipped to relieve chronic OFP . This might indicate that there was a lack of confidence of the dentists in the diagnosis and management for chronic OFP. This situation should be improved via undergraduate and postgraduate dental training and continuing development professional courses, as well as improved patient awareness of chronic OFP [28, 30].
According to a survey in Hong Kong, some barriers exist to accessing the oral health care services. The problem related to the cost of oral health care services could be due to many reasons such as the price information not being available, dental services not being affordable, or a low level of appreciation or value on the cost of care . From our interviews, it was clear that some participants were worried about issues like pain and discomfort during the dental treatment and some were concerned about the cost of dental treatment.
When consulting physicians regarding their OFP, it was unexpected to find that our participants most often did this indirectly. They preferred to consult the physicians during follow-up and/or consultations for other systemic problems, especially at government medical clinics. However, in these situations, the participants complained that the physicians were uninterested and not willing to treat the chronic OFP problems. In Hong Kong, the dissatisfaction on the short consultation but long waiting times, no stable doctor and no freedom to choose physicians to facilitate continuity of care in seeking health care services in the public sector have been already reported . These factors are likely to discourage people from seeking treatment for chronic OFP.
When a curative treatment is not available for chronic OFP, people often expect to be given analgesic medications (“pain killers”) for pain relief. Although analgesics could effectively relief acute pain in the short run, their efficacy in treating chronic pain is probably marginal and controversial . In our study, the majority of participants were reluctant to take the prescribed analgesic because they were concerned about the side effects. Some mentioned that the analgesic could only relieve the pain symptoms temporarily, but it could not cure the OFP completely. Moreover, some participants who had other systemic diseases were concerned about the possibilities of drug interactions between the analgesics and their existing medications. However, considering the widespread use of analgesics, the overall incidence of serious drug-drug interactions involving the analgesics has been relatively low . Thus, even with different available biomedical treatments for chronic pain, more effective complementary and alternative treatments are needed.
Some participants consulted TCM practitioners for the treatment of chronic OFP. They received either internal Chinese herbal medication and/or complementary treatment. TCM has been known for more than 5,000 years and the belief in Chinese medicine is still ingrained in the general Hong Kong population. According to a previous survey, ten percent of the people in Hong Kong would consult TCM practitioners for their illnesses . However, TCM is considered to be a complementary and alternative medicine (CAM) in many Western countries .
“Chi kung” and “Tai Chi” are closely associated with TCM but typically considered as complementary treatments. One of the participants who had received “chi kung” treatment claimed that it was a very effective in relieving her chronic OFP. “Chi kung” or “Qigong” is important in the cultural heritage of China and describes various Chinese systems of ways to improve health both physically and mentally . “Chi kung” has also been found previously to relief chronic OFP .
On the other hand, participants who had received acupuncture and massage claimed that those treatments were not as effective in to relieving their pain. Some reported that acupuncture treatment was effective in short-term pain reduction only. Acupuncture has also been shown to provide a significant short-term pain relief in patients with chronic OFP . However, there was no evidence to support massage therapy was effective to relieve chronic OFP .
Apart from seeking treatment from different health professionals, participants also developed their own coping strategies and described a wide range of various self management techniques which were quite effective in the relief of chronic OFP in most situations. Some of the techniques were suggested by their friends or family. The most commonly used technique was application of the Chinese herbal oil onto the painful region. The herbal remedies employed natural plant preparations for therapeutic effects . Uses of herbal remedies to reduce facial pain have been described, but there is generally insufficient evidence to support its use for chronic pain relief .
The qualitative study approach provided a deeper contextual understanding of the experiences and practices of older adults affected by chronic OFP. Another strength was the location of the study as the accessing of social and community centres increased diversity thus enabling wider insights into the multitude of care pathways (both conventional and traditional) when compared to clinic-based studies. Additionally, inclusion of a community sample as opposed to a clinical sample overcame possible biases of perceptions among a treatment-seeking study group. Data saturation was reached after the 25 interviews (around 1 hour each) and so the sample size was deemed adequate. In qualitative studies, the focus is on context and meaning rather than building a representative view of the population and this approach has limitations. A further limitation is that no clinical objective assessment of chronic OFP was undertaken to confirm chronic OFP diagnoses.
These findings have implications in providing greater ‘in depth’ understanding of the elders experience of chronic OFP with implications to inform the need for services including multidisciplinary specialty clinics. The study highlights the issues faced by elders affected by chronic OFP in the local context (and potentially other populations) and the need to address this problem through community means.