In their August JADA article, "Screening for Psychosocial Risk Factors in Patients With Chronic Orofacial Pain: Recent Advances," Drs. Judith Turner and Samuel Dworkin suggest screening patients with chronic orofacial pain for psychosocial risk factors. Chronic pain produces profound psychological effects, including depression. Psychological screening documents only chronic pain’s effects and not its cause.
Research has demonstrated that psychological stress alone probably will not cause chronic facial pain. Instead, stress can aggravate orofacial pain in susceptible patients. For instance, research demonstrates that patients with a history of temporomandibular disorder, or TMD, were less likely to tolerate bite openings than were patients absent a TMD history.1
Drs. Turner and Dworkin’s literature review confirms the benefit of referral to psychotherapists to assist in chronic pain management. Psychopharmacological agents are particularly useful, although not specifically mentioned in the article. Chronic orofacial pain too often is misdiagnosed as idiopathic, although more extensive examination by specialists can reveal a treatable dental or medical etiology for pain elimination.2
The greatest benefit we can provide our patients remains a correct diagnosis of pain etiology. Pain-eliminating therapy should be our primary therapeutic goal. Psychological chronic pain management will be unnecessary if pain causation can be eliminated.
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