Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20220017
Brazilian Journal of Pain
Case Report

Psychotherapy in the treatment of chronic refractory orofacial pain. Case reports

Psicoterapia no tratamento da dor orofacial crônica refratária. Relato de casos

Marianna Barbosa Yamaguchi; Maria de Fatima Vidotto Oliveira; Silvia Regina DT de Siqueira

Downloads: 0
Views: 51

Abstract

BACKGROUND AND OBJECTIVES: Psychological intervention can contribute to repairing the quality of life and altering behavior while dealing with chronic orofacial pain, especially those that can become refractory to treatments. Thus, the objective of this study was to present the narratives of three patients with refractory chronic neuropathic pain during the process of psychotherapeutic intervention and the follow-up results.

CASE REPORTS: Pain behavior, pain perception and depressive and anxious symptoms were assessed. Patients were under treatment at the Orofacial Pain Clinic and the instruments used in the beginning and end of psychotherapy were the visual analog scale, Beck Inventories (anxiety and depression), Wisconsin Pain Inventory, McGill Pain Questionnaire and Pain Catastrophizing Scale. They attended weekly 50-minute sessions. Each narrative was qualitatively analyzed and the comparison between the evaluations made before and after psychotherapy was included in the context of a phenomenological approach.

CONCLUSION: Emotional familiar conflicts and fear of pain crises were the most important aspects described by these patients. Case 1 presented the less cooperative profile and secondary gains. Despite of that, all cases presented improvement and psychotherapy helped to cope with their problems and pain. There was a remarkable impact on the life of patients as well as on their cooperation with pain treatments while helping the patients to build a proactive attitude and to understand their role in their condition.

Keywords

Chronic pain, Neuropathic orofacial pain. Pain behavior, Psychotherapy, Trigeminal neuralgia

Resumo

JUSTIFICATIVA E OBJETIVOS: A intervenção psicoterapêutica é uma ferramenta importante para melhorar a qualidade de vida de pacientes com dor orofacial crônica, especialmente aqueles que se tornam refratários aos tratamentos. Assim, o objetivo deste estudo foi apresentar, na forma de narrativa, três casos de pacientes com dor facial refratária ao longo do processo de intervenção psicoterapêutica e os resultados obtidos.

RELATO DOS CASOS: Observou-se o comportamento, a percepção da dor e sintomas ansiosos e depressivos. Os pacientes estavam sob tratamento na Equipe de Dor Orofacial e os instrumentos utilizados no início e no final da intervenção foram a escala visual analógica, os Inventários de Beck para Ansiedade e Depressão, o Inventário de Dor de Wisconsin, o Questionário de Dor McGill e a Escala de Catastrofização de Dor. Os pacientes foram atendidos semanalmente em sessões de 50 minutos. Cada narrativa foi analisada qualitativamente e a comparação entre as avaliações (antes e depois do tratamento) foi incluída em um contexto de abordagem fenomenológica.

CONCLUSÃO: Conflitos familiares emocionais e medo das crises de dor foram os aspectos mais importantes descritos pelos pacientes. O caso 1 apresentou um perfil menos cooperador, embora todos tenham apresentado melhora em algum âmbito avaliado. A proposta psicoterapêutica os auxiliou no enfrentamento do sofrimento por conta de seus problemas e da dor. Houve um impacto notável na vida dos pacientes como em sua cooperação com os tratamentos, uma vez que aprender a lidar com seu sofrimento os conduziu a uma postura mais proativa através do entendimento de seus papéis no tratamento da condição dolorosa.

Palavras-chave

Comportamento da dor, Dor crônica, Dor orofacial neuropática, Neuralgia do trigêmeo

References

Bernacchio RMG, Contin I, Mori M. Modifying factors of pain perception. Rev Dor. 2005;3:621-33.

Von Korff M, Dworkin SF, Le Resche L, Kruger A. An epidemiologic comparison of pain complaints. Pain. 1988;32(2):173-83.

Nickel R, Raspe HH. Chronic pain: epidemiology and health care utilization. Nervenarzt. 2001;72(12):897-906.

Watkins EA, Wollan PC, Melton 3rd LJ, Yawn BP. A population in pain: report from the Olmsted Country health study. Pain Med. 2008;9(2):166-74.

Oliveira SB, de Siqueira SR, Sanvovski AR, do Amaral LM, de Siqueira JT. Temporomandibular disorder in Brazilian patients: a preliminary study. J Clin Psychol Med Settings. 2008;15(4):338-43.

Castro AR, Siqueira SR, Perissinotti DM, Teixeira MJ, Siqueira JT. Emotional aspects of chronic orofacial pain and surgical treatment. Int J Surg. 2009;7(3):196-9.

Dagsdóttir LK, Skyt I, Vase L, Baad-Hansen L, Castrillon E, Svensson P. Reports of perceptual distortion of the face are common in patients with different types of chronic orofacial pain. J Oral Rehabil. 2016;43(6):409-16.

de Siqueira SR, Teixeira MJ, de Siqueira JT. Somatosensory investigation of patients with orofacial pain compared with controls. J Neuropsychiatry Clin Neurosci. 2014;26(4):376-81.

Schestatsky P, Ehlers JA, Ehlers BC. Neuropathic pain. Routines in neurology and neurosurgery. 2009:757-67.

Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. J Headache Pain. 2013;14(1):37.

Reddy GD, Viswanathan A. Trigeminal and glossopharyngeal neuralgia. Neurol Clin. 2014;32(2):539-52.

Nasri C, Teixeira MJ, Okada M, Formigoni G, Heir G, Siqueira JT. Burning mouth complaints: clinical characteristics of a Brazilian sample. Clinics. 2007;62(5):561-6.

Bonathan CJ, Zakrzewska JM, Love J, Williams AC. Beliefs and distress about orofacial pain: patient journey through a specialist pain consultation. Oral Facial Pain Headache. 2014;28(3):223-32.

Wielenska RC, Banaco RA. Chronic fatigue syndrome: antibehavior perspective of a case. Themes Psychol. 2010;18:415-24.

Schönenberg M, Mares L, Smolka R, Jusyte A, Zipfel S, Hautzinger M. Facial affect perception and mentalizing abilities in female patients with persistent somatoform pain disorder. Eur J Pain. 2014;18(7):949-56.

Vanderberghe L. Pain behavior. Pain psychology. 2014:15-31.

Goldthorpe J, Peters S, Lovell K, McGowan L, Aggarwal V. ‘I just wanted someone to tell me it wasn’t all in my mind and do something for me’: Qualitative exploration of acceptability of a CBT based intervention to manage chronic orofacial pain. Br Dent J. 2016;220(9):459-63.

Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley DS. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. .

Gorenstein C, Andrade L. Validation of a Portuguese version of the Beck Depression Inventory and the state-trait anxiety inventory in Brazilian subjects. Braz J Med Biol Res. 1996;29(4):453-7.

Teixeira MJ, Yeng LT. Pain evaluation. Pain: clinical manual. 2006:25-38.

Menezes Costa Lda C, Maher CG, McAuley JH, Hancock MJ, de Melo Oliveira W, Azevedo DC. The Brazilian-Portuguese versions of the McGill Pain Questionnaire were reproducible, valid, and responsive in patients with musculoskeletal pain. J Clin Epidemiol. 2011;64(8):903-12.

Azevedo F, Pereira A, Dias C, Agualusa L, Lemos L, Romão J. Translation, cultural adaptation and multicentric study for validation of instruments for the evaluation of chronic pain. Rev Dor. 2007;15(1):6-56.

Nery S, Lauria RA, Sarmento VA, Oliveira MGA. Evaluation of anxiety and depression in patients at the third age and the association with burning mouth syndrome. Rev Cir Med Biol. 2004;3(1):20-9.

Finkelsztejn A. Multiple sclerosis. Routines in neurology and neurosurgery. 2009:351-62.

Oliveira MFV. Psychotherapy in the treatment of facial chronic pain: clinical discussion. Orofacial pain: diagnosis, treatment and quality of life. 2001:149-55.

Mundle R. A narrative analysis of spiritual distress in geriatric physical rehabilitation. J Health Psychol. 2015;20(3):273-85.


Submitted date:
04/16/2021

Accepted date:
04/19/2022

62e06211a9539523c9693064 brjp Articles

BrJP

Share this page
Page Sections