Psychosocial Considerations for Orofacial pain Flashcards
What are psychosocial factors?
Factors that influence a person psychologically or socially.
Multidimensional construcs encompassing several domains such as mood status, cognitive behavioural responses, and social factors.
Why do we care about psychosocial factors with pain?
It has an influence on pain perception.
Strong association of cognition and sociality to pain perception
What is the biopsychosocial model of pain?
Integration of psychological, social factors with traditional medical factors to better understand and ultimately manage, the process of disease and illness across time and circumstance
How does chronic pain differ from acute pain in the biopsychosocial model of pain?
Chronic pain is influenced more by psychosocial input and can cause pain to last longer
Which psychosocial factors are most relevant in persistent orofacial pain?
Depression
Anxiety
Somatoform disorders
Catastrophizing and Self-Efficacy
Fear avoidance
How does depression affect pain?
Decreased pain modulation
Decreased self-efficacy
Inactivity
Symptom amplification
Doctor shopping
How does anxiety affect pain?
Amplified pain perception with resultant hypervigilance
Physiologically correlates with increased heart rate, muscle tone, and sweating
Behavioural correlates include: Twitching behaviour, rapid speech
Distinct from depression but can occur with depression
How does TMD correlate with depression and anxiety?
Depression or anxiety are more prevalent in patients with TMD
F > M
Patients with TMD more likely to suffer from social isolation, sleep dysfunction, daytime sleepiness, difficulty with concentration
Patients with depression and anxiety are harder to manage.
Depression and anxiety can correlate with lots of intraoral burning symptoms
What are somatoform disorders?
Disorders contained within this group involve reporting of physical symptoms not accompanied by appropriate signs supportive of a disease diagnosis
What is somatization?
High symptom reporting without a disease diagnosis and accompanied by use of the symptoms to avoid social or day-to-day responsibility
What are the mechanisms behind somatisation?
Increased tendency to report about the body – extreme cases: hypochondriasis
Hypervigilance resulting in report of experiences to everyone
E.g occlusal dysaesthesia
Changes in body that are accurately detected and perceived, reflect interoception, experience of our bodily states outside the special senses
What conditions are associated with functional somatic syndromes?
Chronic widespread pain, Fibromyalgia, Headaches/migraines, Vulvodynia, IBS, Chronic back pain, Chronic fatigue syndrome, Interstitial cystitis
What is occlusal dysaesthesia?
Condition in which tooth contacts that are not clinically identifiable as premature contacts nor associated with other disorders have been perpetually perceived as disturbing or unpleasant
Affected patients suffer from severe psychological and psychosocial stress
How does TMD relate to somatization?
Strong association between somatisation and TMD onset.
What is catastrophising and self efficacy?
Catastrophising: exaggerated negative mental state during actual and anticipated painful stimulation.
Self-efficacy: refers to the level of belief an individual has in their own ability to plan and bring about a course of actions for their own benefit
What are the 3 characteristics for catastrophizing?
Rumination
Magnification
Helplessness
What are the outcomes of catastrophizing on chronic orofacial pain?
Determinant of pain related outcomes
Baseline catastrophising strongly associated with increased pain intensity
Increase the risk of transition from acute to chronic TMD pain
Predictor of pain-related interference
Mediator between psychological distress and pain interference
Helplessness is noted to have highest influence on pain related interference and predictor of disability in patients with orofacial pain
What is fear avoidance and how does it lead to chronic pain?
Psychiatric model describing reporting pain despite pathology not being seen clinically.
Pain avoiding behaviour creates a cycle of avoidance of pain and disuse/disability/depression leading to further pain.
This is applicable for TMD
How does history of adversity affect vulnerability to distress?
History of adversity could increase vulnerability to emotional distress, or increase the tendency to attend, amplify and overinterpret somatic symptoms
Unclear relationship between when adversity occurs and if chronic pain will manifest
Higher proportion of patients with TMD have history of physical and/or sexual abuse
Higher proportion of female TMD patients report sexual or physical abuse compared to matched controls
Significantly higher levels of anxiety, depression and somatic symptoms
What risk factors are associated with TMD?
F > M
Somatisation
Life dissatisfaction
History of physical abuse
History of sexual abuse
Parental depression during childhood
How can a psychosocial history be taken?
Behavioural: Sleep (hours, daytime sleepiness, trouble sleeping?) Diet (Caffeine, alcohol, and recreational drugs) Tobacco (pack years)
Social: Effect of pain on daily life, work interference and financial stress, home life (support systems and partner support), has pain changed marriage and satisfaction, disability pension?, social life effects.
Emotional: Mood during the week, Anxiety, frustration, self-esteem, childhood trauma, relationship with family, suicidal thoughts.
How can psychosocial factors be managed?
Early education, encourage principles of self–management, psych referral
Physical self regulation
Mindfulness
Biofeedback
CBT
Distraction
Breathing control
Relaxation
