Treating the TMD/Chronic Pain Patient: Psychiatry and Psychology
From the outside, it has been very common for clinicians to dismiss TMJ patients as “crazy,” “difficult,” or “high maintenance.” This sentiment conveyed both a lack of knowledge of TMJ pathology and mental illness on the part of the health professions. Fo
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Treating the TMD/Chronic Pain Patient: Psychiatry and Psychology Sue Gritzner, Valerie Jackson, Irina Strigo, and David Spiegel
Abstract
From the outside, it has been very common for clinicians to dismiss TMJ patients as “crazy,” “difficult,” or “high maintenance.” This sentiment conveyed both a lack of knowledge of TMJ pathology and mental illness on the part of the health professions. Fortunately, the true situation is gradually coming to light, and doctors are gaining an increased appreciation for how connected the mind and body really are. In fact, there is no true separation at all; it has always been something we created to make sense of a system we did not understand. Fortunately, our ideas of how the mind and body interact have evolved, and it is unmistakably critical to be able to assess both the mind and body together in order to ultimately make an ailing person whole again. This chapter is devoted to explaining how psychologists and psychiatrist evaluate, diagnose, and treat TMD/chronic pain patients.
8.1
hronic Pain from a Psychiatric/Psychological C Perspective
From a biopsychosocial perspective, the role of psychological assessment and intervention is integral to the treatment of all medical conditions, to the extent that the psychosocial factors are impacting treatment and outcomes for each particular S. Gritzner (*) · V. Jackson UCSF Medical Center, Pain Management Center, San Francisco, CA, USA e-mail: [email protected]; [email protected] I. Strigo Department of Psychiatry, UCSF Medical Center, San Francisco, CA, USA e-mail: [email protected] D. Spiegel EVMS Department of Psychiatry and Behavioral Sciences, Norfolk, VA, USA e-mail: [email protected] © Springer Nature Switzerland AG 2019 S. T. Connelly et al. (eds.), Contemporary Management of Temporomandibular Disorders, https://doi.org/10.1007/978-3-319-99912-8_8
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person. Factors such as depression, anxiety, catastrophizing, and pain acceptance have all been linked to pain outcomes. As a result, it is crucial that when present, these factors be addressed in tandem or prior to medical interventions. At a minimum, psychological interventions can prepare patients for medical interventions and give patients realistic expectations and perspective on their situation. For instance, when a patient has a phobia of needles, this must be addressed prior to Botox injections with the help of exposure therapy. A patient with depression may be reluctant to eat, but then only willing to do so in larger quantities at a time, causing more pain. This can be addressed by teaching pacing skills and using cognitive restructuring.
8.2
Characterization of the Problem
Psychological assessments typically include a combination of a clinical interview and self-administered assessment forms. The goal is then to develop a case conceptualization to identify potential sources of physical and emotional problems, dysfunctional behavioral patterns, and current level of distress and disruption due to these symptoms [1] and t
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