Refractory Orofacial Pain: Is It the Patient or the Pain?

Aims: To highlight and discuss the term "refractory" when used to describe pain conditions and its application to orofacial pain, as well as to highlight the factors that must be considered in a refractory patient.

Methods: A scoping review of recent publications (2010 to 2021) applying the term "refractory" to orofacial pain was conducted, and this paper presents their limitations and definitions.

Results: The term "refractory" is often used to describe pain instead of "persistent" or "nonresponsive." There are clear definitions in the use of refractory for migraine, cluster headaches, and other nonheadache disorders. Currently, the term is applied to pain conditions in order to alter the patient pathway of treatment, sometimes to escalate a patient from one care sector to another and sometimes to escalate treatment to more costly surgical interventional techniques.

Conclusion: There is a need for a clear definition for use of the term "refractory" in orofacial pain conditions, excluding migraine and cluster headaches. In addition, there is a requirement for a consensus on the implications of the use of refractory when assessing and managing patients.