Posttraumatic Stress Disorder and the Role of Psychosocial Comorbidities in Chronic Orofacial Pain - 18/11/22

Doi : 10.1016/j.cden.2022.07.011

Roxanne Bavarian, DMD, DMSc ^a,^b,^⁎ , Michael E. Schatman, PhD ^c,^d,^e, Ronald J. Kulich, PhD ^f,^g,^h
^a Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, #230, Boston, MA 02114, USA
^b Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA 02115, USA
^c Department of Anesthesiology, Perioperative Care, & Pain Medicine, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY 10016, USA
^d Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY 10016, USA
^e School of Social Work, North Carolina State University, 10 Current Dr, Raleigh, NC 27607, USA
^f Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
^g Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
^h Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA

^∗Corresponding author. Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, 188 Longwood Ave, Boston, MA, 02115, USADepartment of Oral and Maxillofacial SurgeryMassachusetts General Hospital55 Fruit Street, #230BostonMA02114

Résumé

This article presents the case of a patient with persistent right-sided jaw pain with a history of multiple temporomandibular joint surgeries in the setting of persistent widespread body pain, the causes of which were fibromyalgia and osteoarthritis with multiple joint replacements, as well as psychological diagnoses of PTSD and depression. Despite extensive treatment from her orofacial pain team in combination with neurology and neurosurgery, her severe pain persisted, likely due to the consequences of untreated PTSD and depression, which led to avoidance of activities that would exacerbate her pain and thus to further disability and emotional deterioration.

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Keywords : TMJ, TMD, Orofacial pain, Facial pain, Chronic pain, PTSD, Trauma, Behavioral care

Plan

Key points

Case presentation

The association of psychosocial comorbidities in chronic orofacial pain

Psychological assessment of the patient with orofacial pain

Management of patients with orofacial pain with posttraumatic stress disorder

Behavioral therapy

Interdisciplinary pain rehabilitation programs

Psychopharmacology

Long-term opioid therapy

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Vol 67 - N° 1

P. 141-155 - janvier 2023 Retour au numéro

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Posttraumatic Stress Disorder and the Role of Psychosocial Comorbidities in Chronic Orofacial Pain - 18/11/22

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