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

http://dx.doi.org/10.5935/2595-0118.20220017 BrJP, vol.5, n2, p.172-177, 2022
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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

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Submitted date:
04/16/2021

Accepted date:
04/19/2022

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