Assessment of the Psychological Comorbidity, Pathophysiological Mechanisms, and Treatment Implications in Patients with Chronic Orofacial Pain

Abstract

Chronic orofacial pain is a multifaceted health problem that like many other forms ofchronic pain bears deleterious effects upon quality of life as well as psychological andphysiological well-being. Due to a poorly understood etiology, effective treatment strategies are lacking and tend to lack a guiding integrative conceptual framework toform the basis and development of intervention. This review seeks to provide an updatedreview of the comorbid psychological disorders and characteristics that are common among chronic orofacial pain patients, while also examining the pathophysiological mechanisms underlying orofacial pain. Rather than consider the emotional, cognitive, andneuroendocrine influences upon pain perception and severity individually, these factorsshould be viewed as working in concert with one another. It is this interplay amongst distinct psychological characteristics governing the patient along with physiologicalmechanisms that exacerbate the pain. Together, the goal is to identify unique characteristics surrounding orofacial pain and offer some plausible insights for effectivetreatment outcomes. Stage 2 Stage 3 Stage 1 Acute Phase Emotional vigilance (e.g., fear) Consideration of medical care Chronic Phase Psychosocial issues Behavioral complications Most Chronic Phase Psychopathology Heightened symptom presentation Figure 1: Development from acute to chronic pain.

Comparison of Risk Factors in Patients With Acute and Chronic Orofacial Pain

“…9 There are various chronic pain conditions occurring in the orofacial region, including neuropathic pain, myofascial pain/temporomandibular joint (TMJ) syndrome, and glossodynia. 10,11 Correct diagnosis can be difficult due to the complex anatomy and neurophysiology of the orofacial complex, as well as numerous biopsychosocial factors. 12,13 Although previous research into the psychological state of patients with chronic orofacial pain focused on particular diseases or compared chronic pain patients with healthy individuals, [14][15][16] few studies in the dental field have compared the characteristics of patients with acute or chronic pain.…”