Litigation and chronic facial pain.

Clinical studies have suggested that the presence of litigation in chronic pain syndromes may complicate diagnostic and treatment strategies. In addition, psychosocial factors may be prevalent in such cases. The present study explored the possible correlation in the facial pain population between patients in litigation and psychological disturbance as measured by the Minnesota Multiphasic Personality Inventory. Beck Depression Inventory and Wahler Symptom Checklist scores also were compared. One hundred eleven patients diagnosed with chronic facial pain were asked if they currently were involved in litigation related to their medical complaints. The result revealed that 18% of the 111 patients were in litigation at the time of their initial visit. The Minnesota Multiphasic Personality Inventory profiles showed that 45% of the litigation patients had four or more clinical scales above 70 (significantly elevated) on the Minnesota Multiphasic Personality Inventory. In contrast, only 18% of the patients who were not in litigation had four or more scales above the 70 criteria. Beck and Wahler scores also were more elevated for the litigation group. The results of the study indicate that chronic facial pain patients in litigation may present with more psychological disturbance as compared to those patients not in litigation.

Comparison of MMPI scores with self-report of sleep disturbance and bruxism in the facial pain population.

Sleep disturbance and bruxism are common clinical characteristics of the chronic facial pain patient. Previous studies have shown that chronic pain patients reporting disturbed sleep show more psychopathology and respond less readily to treatment. Bruxism has been linked to emotional stress and periods of difficult life change. The present study explored the question of whether sleep disturbance or bruxism are useful predictors of psychopathology in the facial pain population. Psychopathology was measured by using the Minnesota Multiphasic Personality Inventory (MMPI). It was predicted that facial pain patients who reported sleep disturbance or bruxism would correlate with more elevated scores on the MMPI profiles. The results of the study revealed a strong association between self-report of disturbed sleep and higher MMPI scores. No difference between the MMPI scores of bruxers and non-bruxers was found. It was concluded that sleep disturbance may be an effective predictor of psychological disturbance within the facial pain population, while bruxism was not found to be associated with psychological disturbance as measured by the MMPI.

Lateralization of chronic facial pain: fact or fiction.

Previous studies have shown that pain is generally reported more on the left side of the body. It has been hypothesized that patient report of left pain dominance may be due to the right hemisphere being less efficient in processing cutaneous sensory input while being dominant for emotional experience as compared with the left hemisphere of the brain. Only in cases of trigeminal neuralgia has self-report of pain been lateralized to the right side. Due to previous research findings, we postulated that other facial pain diagnoses may demonstrate a right-sided dominance due to the lack of neural crossover in the facial region. The results of the study found no significant difference between self-report of right- and left-sided facial pain within four diagnostic categories. It was concluded that the results of right lateralized pain with trigeminal neuralgia should not be generalized to the facial pain population as a whole.

Comparison of clinical characteristics in myogenic, TMJ internal derangement and atypical facial pain patients.

Temporomandibular joint (TMJ) disorders have been collectively grouped as myofascial pain-dysfunction syndrome (MPDS) or temporomandibular joint dysfunction syndrome (TMJDS). In the past, these terms have been used synonomously to describe a set of clinical signs and symptoms that include pain in the TMJ and muscles of mastication, limited or deviant opening of the mandible, and/or joint sounds. The present study segregated two major subgroups subsumed within this diagnostic classification and assigned them to a myogenic facial pain (MFP) group and a TMJ internal derangement (TMJID) group. Previous studies may have included both of these disorders as MPDS/TMJDS. While some signs and symptoms are similar, the primary differentiation is based on meniscus displacement present with TMJID patients and pain distribution patterns between the two groups. While MFP/TMJID patients comprise the majority of the facial pain population, a third major group of patients is encountered, being classified under the diagnostic appellation of atypical facial pain (AFP). Patients with AFP usually complain of vague and wandering pain in the maxilla or mandible; however, no identifiable source of infection or organic disease can be uncovered. One hundred fifty patients seeking consultation and care for facial pain met the criteria for inclusion into one of three clinical groups. The groups were compared for age, sex, duration of symptoms, bruxism and/or clenching habits, and disturbed sleep patterns. Differences in surface electromyographic levels from the facial and cervical muscles were also examined. Minnesota Multiphasic Personality Inventory (MMPI) scores from 95 subjects were compared with self-report measures of depression and anxiety. It was concluded that subcategorization of myofascial pain dysfunction patients into a MFP and TMJID group is justified on the basis of psychometric differences, clenching habits, masseter EMG levels, and male:female ratio. Furthermore, psychopathological factors are more significant among MFP and AFP subjects than TMJID patients.

Psychological and behavioral aspects of chronic facial pain.

This article provides an overview of psychological and behavioral factors contributing to chronic facial pain. Psychiatric diagnostic issues are presented from the perspective of the primary treating physician or dentist, with emphasis on practical ways of identifying and managing patients with psychosocial complications of their presenting complaints. Behavioral factors contributing to facial pain, including parafunctional habits such as bruxism and muscular tension, and their connection to stress are discussed. Various behavioral and psychological treatment approaches are reviewed.