[Psychic and somatic findings in jaw or facial pain of unclear origin. Comparison of patients with severe and mild symptoms].
BACKGROUND
Both for medical and dental specialists, patients with facial arthromyalgia (FAM) and acute or chronic atypical facial pain (AFP) often represent a clinical challenge. Only few empirical studies address the possible interaction between facial pain and increased psychosocial stress with a thereby heightened risk for a chronic course of disease.


OBJECTIVE
To evaluate whether FAM or AFP - patients initially presenting with high vs. low pain intensity differ in somatic, psychosocial and socioeconomic parameters.


METHODS
We chose to study a population with a primary diagnosis of myofascial pain of the jaw muscles or atypical facial pain and excluded patients with disc displacement, acute arthritis and severe arthrosis. Within nine months, 124 consecutive patients with FAM ( n=108) or AFP ( n=16) were referred to the departments of maxillary surgery, dentistry or neurology of two interdisciplinary academic pain centers. Using the patients'ratings on a 100 mm visual analogue scale concerning their pain intensity, the group was divided in a subgroup initially presenting with low (VAS</=5; n=50) and high pain (VAS>5; n=45). Psychometric evaluation was conducted with the SCL-90R (general psychopathology), the State-Trait-Anger-Expression Inventory (STAXI) and a special questionnaire addressing different aspects of chronic pain (modified SBAS-IV). All patients were assessed by a maxillary surgeon/specialized dentist with the help of a detailed, standardized clinical examination (Helkimo-Index).


RESULTS
The group of FAM-/AFP - patients according to our inclusion-/exclusion - criteria presenting with a high pain intensity showed more psychosocial withdrawal ( p=0.013), a worse self-rated psychological status ( p=0.033) and a trend towards more somatization ( p=0.093) than patients with lower pain intensity. There was no correlation between initial pain intensity and somatic parameters of disease as assessed by the standardized clinical examination. Low educational status proved to be the best predictor (p<0.001) for belonging to the high (extensive) pain group.


CONCLUSIONS
These data suggest that FAM-/ AFP - patients initially presenting with a high pain intensity have an increased risk for psychosocial stress and maladaptive coping behaviour. As both variables are empirically validated risk factors for a chronic course in pain-related disease, these patients should be of special interest for an interdisciplianary therapeutic setting including psychotherapeutic approaches.
Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie, Klinikum rechts der Isar, TU München, Germany. H.Guendel@lrz.tu-muenchen.de
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Gündel
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Ladwig
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Wolowski
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Fischer
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Grübl
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Marten-Mittag
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Kolk
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Scheutzel
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Hammes
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Neff
D000208:Acute Disease; D000786:Anger; D002908:Chronic Disease; D003710:Demography; D004522:Educational Status; D005157:Facial Pain / Q000503:physiopathology* / Q000523:psychology*; D005190:Family; D005260:Female; D006801:Humans; D008297:Male; D008410:Masticatory Muscles / Q000503:physiopathology*; D010147:Pain Measurement; D012959:Socioeconomic Factors; D013997:Time Factors