Exploring Cognitive, Behavioral, and Psychological Dimensions in Persistent Idiopathic Facial Pain and Other Chronic Orofacial Pain Conditions

BACKGROUND: Chronic orofacial pain (COP) is a complex condition often resistant to treatment and associated with psychological comorbidities. Yet, its neuropsychological profile remains under-investigated. This case-control study aims to identify the cognitive, behavioral, and psychological profiles of COP and their associations with clinical symptoms, with a focus on persistent idiopathic facial pain (PIFP), a condition particularly underexplored. METHODS: A cohort of 42 patients (COPc), including 23 with PIFP, and 42 healthy controls (HCs) underwent a comprehensive assessment of mood, coping strategies, personality traits, cognitive functioning, and social well-being. Between-group and correlation analyses were performed, and Bonferroni correction was applied to account for multiple comparisons. RESULTS: The psychological framework of COPc was marked by depressive symptoms, loneliness, alexithymia, poor quality of life, and low physical and mental well-being. Personality assessment indicated worthlessness. Catastrophizing was a dominant coping strategy, characterized by helplessness and rumination. Cognitive assessments revealed deficits in attention and executive functions. PIFP patients exhibited particularly psychological vulnerabilities, namely, catastrophizing thinking and difficulties in describing their own feelings. Correlation analyses showed complex relationships between cognitive, behavioral, and psychological impairments in COPc, and a strong association between the negative impact of pain symptoms on social life and psychological, catastrophizing, and cognitive functioning. CONCLUSIONS: This is the first study to characterize the neuropsychological profile of PIFP and COP conditions, revealing a complex interplay of cognitive, behavioral, and psychological vulnerabilities. These findings underscore the importance of addressing both neuropsychological and social functioning in the management of chronic pain to improve patient well-being.