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Treating the TMD/Chronic Pain Patient: Psychiatry and Psychology

  • Sue GritznerEmail author
  • Valerie Jackson
  • Irina Strigo
  • David Spiegel
Chapter

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.

Keywords

Temporomandibular Pain Psychology Psychiatry 

References

  1. 1.
    JWS V, Morley SJ, Linton SJ, Boersma K, de Jong J, editors. Pain-related fear: exposure-based treatment of chronic pain. 1st ed. Washington, DC: IASP-Press; 2012.Google Scholar
  2. 2.
    Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.Google Scholar
  3. 3.
    Cleeland CS. Measurement of pain by subjective report. In: Chapman DR, Loeser JD, editors. Advances in pain research and therapy: issues in pain measurement, vol. 12. New York: Raven Press; 1989. p. 391–403.Google Scholar
  4. 4.
    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.PubMedGoogle Scholar
  5. 5.
    McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain. 1992;50(1):67–73.PubMedGoogle Scholar
  6. 6.
    Sullivan ML. The pain catastrophizing scale-user manual. Montreal: McGill University; 2009.Google Scholar
  7. 7.
    Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain. 2007;11(2):153–63.PubMedGoogle Scholar
  8. 8.
    Bruns D, Disorbio JM. Battery for health improvement 2 manual. Minneapolis: Pearson; 2003.Google Scholar
  9. 9.
    Roldan-Barraza C, Janko S, Villanueva J, Araya I, Lauer HC. A systematic review and meta-analysis of usual treatment versus psychosocial interventions in the treatment of myofascial temporomandibular disorder pain. J Oral Facial Pain Headache. 2014;28(3):205–22.PubMedGoogle Scholar
  10. 10.
    Randhawa K, Bohay R, Cote P, van der Velde G, Sutton D, Wong JJ, et al. The effectiveness of noninvasive interventions for temporomandibular disorders: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Clin J Pain. 2016;32(3):260–78.PubMedGoogle Scholar
  11. 11.
    Shedden Mora MC, Weber D, Neff A, Rief W. Biofeedback-based cognitive-behavioral treatment compared with occlusal splint for temporomandibular disorder: a randomized controlled trial. Clin J Pain. 2013;29(12):1057–65.PubMedGoogle Scholar
  12. 12.
    Ferrando M, Galdon MJ, Dura E, Andreu Y, Jimenez Y, Poveda R. Enhancing the efficacy of treatment for temporomandibular patients with muscular diagnosis through cognitive-behavioral intervention, including hypnosis: a randomized study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(1):81–9.PubMedGoogle Scholar
  13. 13.
    Barry DT, Cutter CJ, Beitel M, Kerns RD, Liong C, Schottenfeld RS. Psychiatric disorders among patients seeking treatment for co-occurring chronic pain and opioid use disorder. J Clin Psychiatry. 2016;77(10):1413–9.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Fishbain DA, Cole B, Lewis JE, Gao J. Does pain interfere with antidepressant depression treatment response and remission in patients with depression and pain? An evidence-based structured review. Pain Med. 2014;15(9):1522–39.PubMedGoogle Scholar
  15. 15.
    Howe CQ, Sullivan MD. The missing ‘P’ in pain management: how the current opioid epidemic highlights the need for psychiatric services in chronic pain care. Gen Hosp Psychiatry. 2014;36(1):99–104.PubMedGoogle Scholar
  16. 16.
    Lepine JP, Briley M. The epidemiology of pain in depression. Hum Psychopharmacol. 2004;19(Suppl 1):S3–7.PubMedGoogle Scholar
  17. 17.
    Teh CF, Zaslavsky AM, Reynolds CF III, Cleary PD. Effect of depression treatment on chronic pain outcomes. Psychosom Med. 2010;72(1):61–7.PubMedGoogle Scholar
  18. 18.
    Wasan AD, Michna E, Edwards RR, Katz JN, Nedeljkovic SS, Dolman AJ, et al. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology. 2015;123(4):861–72.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Melzack R, Casey KL, Kenshalo DR. Sensory, motivational and central control determinants of pain: a new conceptual model. In: Kenshalo DR, editor. The skin senses, vol. I. Springfield: Charles C. Thomas; 1968. p. 423–43.Google Scholar
  20. 20.
    Merskey H, Bogduk N. IASP task force on taxonomy: classification of chronic pain: description of chronic pain syndromes and definition of pain terms. Seattle: IASP Press; 1994.Google Scholar
  21. 21.
    Strigo IA, Bushnell MC, Boivin M, Duncan GH. Psychophysical analysis of visceral and cutaneous pain in human subjects. Pain. 2002;97(3):235–46.PubMedGoogle Scholar
  22. 22.
    Rainville P, Feine JS, Bushnell MC, Duncan GH. A psychophysical comparison of sensory and affective responses to four modalities of experimental pain. Somatosens Mot Res. 1992;9(4):265–77.PubMedGoogle Scholar
  23. 23.
    Price DD. Psychological and neural mechanisms of the affective dimension of pain. Science. 2000;288(5472):1769–72.PubMedGoogle Scholar
  24. 24.
    Fields HL. Pain modulation: expectation, opioid analgesia and virtual pain. Prog Brain Res. 2000;122:245–53.PubMedGoogle Scholar
  25. 25.
    Villemure C, Slotnick BM, Bushnell MC. Effects of odors on pain perception: deciphering the roles of emotion and attention. Pain. 2003;106(1–2):101–8.PubMedGoogle Scholar
  26. 26.
    Strigo IA, Carli F, Bushnell MC. Effect of ambient temperature on human pain and temperature perception. Anesthesiology. 2000;92(3):699–707.PubMedGoogle Scholar
  27. 27.
    Villemure C, Bushnell MC. Cognitive modulation of pain: how do attention and emotion influence pain processing? Pain. 2002;95(3):195–9.PubMedGoogle Scholar
  28. 28.
    Zelman DC, Howland EW, Nichols SN, Cleeland CS. The effects of induced mood on laboratory pain. Pain. 1991;46(1):105–11.PubMedGoogle Scholar
  29. 29.
    Conner TS, Tennen H, Zautra AJ, Affleck G, Armeli S, Fifield J. Coping with rheumatoid arthritis pain in daily life: within-person analyses reveal hidden vulnerability for the formerly depressed. Pain. 2006;126(1–3):198–209.PubMedGoogle Scholar
  30. 30.
    Walsh TM, Smith CP, McGrath PJ. Pain correlates of depressed mood. Pain Res Manag. 1998;3(3):135–44.Google Scholar
  31. 31.
    Ackerman MD, Stevens MJ. Acute and chronic pain: pain dimensions and psychological status. J Clin Psychol. 1989;45(2):223–8.PubMedGoogle Scholar
  32. 32.
    Bear DM. Hemispheric specialization and the neurology of emotion. Arch Neurol. 1983;40(4):195–202.PubMedGoogle Scholar
  33. 33.
    Ushinsky A, Reinhardt LE, Simmons AN, Strigo IA. Further evidence of emotional allodynia in unmedicated young adults with major depressive disorder. PLoS One. 2013;8(11):e80507.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Strigo IA, Simmons AN, Matthews SC, Craig AD, Paulus MP. Increased affective bias revealed using experimental graded heat stimuli in young depressed adults: evidence of “emotional allodynia”. Psychosom Med. 2008;70(3):338–44.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Mutschler I, Ball T, Wankerl J, Strigo IA. Pain and emotion in the insular cortex: evidence for functional reorganization in major depression. Neurosci Lett. 2012;520(2):204–9.PubMedGoogle Scholar
  36. 36.
    Strigo IA, Simmons AN, Matthews SC, Craig AD, Paulus MP. Association of major depressive disorder with altered functional brain response during anticipation and processing of heat pain. Arch Gen Psychiatry. 2008;65(11):1275–84.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Strigo IA, Matthews SC, Simmons AN. Decreased frontal regulation during pain anticipation in unmedicated subjects with major depressive disorder. Transl Psychiatry. 2013;3:e239.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Tennen H, Affleck G, Zautra A. Depression history and coping with chronic pain: a daily process analysis. Health Psychol. 2006;25(3):370–9.PubMedGoogle Scholar
  39. 39.
    Zautra AJ, Parrish BP, Van Puymbroeck CM, Tennen H, Davis MC, Reich JW, et al. Depression history, stress, and pain in rheumatoid arthritis patients. J Behav Med. 2007;30(3):187–97.PubMedGoogle Scholar
  40. 40.
    Giesecke T, Gracely RH, Williams DA, Geisser ME, Petzke FW, Clauw DJ. The relationship between depression, clinical pain, and experimental pain in a chronic pain cohort. Arthritis Rheum. 2005;52(5):1577–84.PubMedGoogle Scholar
  41. 41.
    Rainville P, Duncan GH, Price DD, Carrier B, Bushnell MC. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science. 1997;277(5328):968–71.PubMedGoogle Scholar
  42. 42.
    Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3(8):655–66.PubMedGoogle Scholar
  43. 43.
    Craig AD. How do you feel—now? The anterior insula and human awareness. Nat Rev Neurosci. 2009;10(1):59–70.PubMedGoogle Scholar
  44. 44.
    Craig AD. How do you feel?: an interoceptive moment with your neurobiological self. Princeton: Princeton University Press; 2015.Google Scholar
  45. 45.
    Strigo IA, Murray SB, Simmons AN, Bernard RS, Huang JS, Kaye WH. The clinical application of fMRI data in a single-patient diagnostic conundrum: classifying brain response to experimental pain to distinguish between gastrointestinal, depressive and eating disorder symptoms. J Clin Neurosci. 2017;45:149–53.PubMedGoogle Scholar
  46. 46.
    Goodkind M, Eickhoff SB, Oathes DJ, Jiang Y, Chang A, Jones-Hagata LB, et al. Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry. 2015;72(4):305–15.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Strigo IA, Matthews SC, Simmons AN. Right anterior insula hypoactivity during anticipation of homeostatic shifts in major depressive disorder. Psychosom Med. 2010;72(3):316–23.PubMedPubMedCentralGoogle Scholar
  48. 48.
    Anamkath NS. An interdisciplinary pain rehabilitation program for veterans with chronic pain: description and initial evaluation of outcomes. Pain Res Manag. 2018;2018:3941682.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Seminowicz DA, Shpaner M, Keaser ML, Krauthamer GM, Mantegna J, Dumas JA, et al. Cognitive-behavioral therapy increases prefrontal cortex gray matter in patients with chronic pain. J Pain. 2013;14(12):1573–84.PubMedGoogle Scholar
  50. 50.
    Yoshimura S, Okamoto Y, Onoda K, Matsunaga M, Okada G, Kunisato Y, et al. Cognitive behavioral therapy for depression changes medial prefrontal and ventral anterior cingulate cortex activity associated with self-referential processing. Soc Cogn Affect Neurosci. 2014;9(4):487–93.PubMedGoogle Scholar
  51. 51.
    Hooten WM. Chronic pain and mental health disorders: shared neural mechanisms, epidemiology, and treatment. Mayo Clin Proc. 2016;91(7):955–70.PubMedGoogle Scholar
  52. 52.
    Wasan AD, Alpay M, Nejad SH. Pathophysiology, psychiatric co-morbidity, and treatment of pain. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts General Hospital psychopharmacology and neurotherapeutics. 1st ed. London: Elsevier; 2016. p. 199–209.Google Scholar
  53. 53.
    Moultry AM, Poon IO. The use of antidepressants for chronic pain. US Pharm. 2009;34(5):26–34.Google Scholar
  54. 54.
    Jaracz J, Gattner K, Jaracz K, Gorna K. Unexplained painful physical symptoms in patients with major depressive disorder: prevalence, pathophysiology and management. CNS Drugs. 2016;30(4):293–304.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Kroenke K, Bair MJ, Damush TM, Wu J, Hoke S, Sutherland J, et al. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. 2009;301(20):2099–110.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Bajwa ZH, Simopoulos TT, Pal J, Kraemer JJ, Chopra P, Nagda JV, et al. Low and therapeutic doses of antidepressants are associated with similar response in the context of multimodal treatment of pain. Pain Physician. 2009;12(5):893–900.PubMedGoogle Scholar
  57. 57.
    Obata H. Analgesic mechanisms of antidepressants for neuropathic pain. Int J Mol Sci. 2017;18(11). pii: E2483.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Sue Gritzner
    • 1
    Email author
  • Valerie Jackson
    • 1
  • Irina Strigo
    • 2
  • David Spiegel
    • 3
  1. 1.UCSF Medical Center, Pain Management CenterSan FranciscoUSA
  2. 2.Department of PsychiatryUCSF Medical CenterSan FranciscoUSA
  3. 3.EVMS Department of Psychiatry and Behavioral SciencesNorfolkUSA

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