Chronic orofacial pain (COFP) is a complex condition influenced by a dynamic interplay of biological, psychological, and social factors. Among the psychosocial contributors, anxiety, depression, and catastrophizing are particularly significant in shaping the pain experience and its impact on daily life.
Anxiety, Depression, and Catastrophizing
- Prevalence and Impact: Individuals with COFP have a markedly higher prevalence of anxiety and depression compared to those without chronic pain. Studies indicate that the severity of pain and the presence of comorbid conditions, such as migraines, further increase the likelihood of these psychological symptoms13.
- Pain Perception and Disability: Psychological distress, including anxiety and depression, not only exacerbates pain perception but also contributes to greater pain-related disability and impaired quality of life125.Catastrophizing—characterized by an exaggerated negative orientation toward pain—can amplify pain intensity, hinder coping, and is associated with poorer treatment outcomes6.
- Bidirectional Relationship: The relationship is bidirectional; chronic pain can lead to psychological distress, while pre-existing psychological issues can predispose individuals to develop persistent pain or worsen its course6. This cycle can result in increased social isolation, financial strain, and disrupted family functioning35.
Role of Cognitive Behavioral Therapy (CBT)
- Evidence-Based Intervention: Cognitive Behavioral Therapy is one of the most researched and effective psychosocial interventions for managing chronic orofacial pain. CBT addresses maladaptive thoughts and behaviors, such as catastrophizing, and equips patients with coping strategies to manage both pain and its psychological consequences25.
- Mechanisms of Benefit: CBT helps patients reframe negative thoughts, reduce avoidance behaviors, and develop resilience. It can decrease pain intensity, improve mood, and enhance overall functioning5.
- Integration into Care: Despite its proven benefits, psychological interventions like CBT remain underutilized in standard dental and pain management settings. There is a pressing need for greater integration of accessible psychosocial programs into multidisciplinary care for COFP25.
- Other Interventions: In addition to CBT, approaches such as relaxation techniques and biofeedback have shown feasibility and potential utility in this population5.
Conclusion
Psychosocial factors—especially anxiety, depression, and catastrophizing—play a central role in the onset, maintenance, and exacerbation of chronic orofacial pain. Addressing these factors through interventions like Cognitive Behavioral Therapy is essential for effective, long-term pain management and improved quality of life1256. Embedding psychological care within standard treatment protocols is crucial for meeting the comprehensive needs of individuals living with chronic orofacial pain.
Citations:
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10586586/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC5727744/
- https://www.crd.york.ac.uk/PROSPEROFILES/43703_STRATEGY_20160710.pdf
- https://www.jofph.com/articles/10.11607/ofph.3010
- https://www.dovepress.com/i-still-suffer-every-second-of-every-day-a-qualitative-analysis-of-the-peer-reviewed-fulltext-article-JPR
- https://orofacialpain.org.uk/education/psychosocial-aspect-of-orofacial-pain/
- https://www.sciencedirect.com/science/article/abs/pii/S0149763421002475
- https://www.diva-portal.org/smash/get/diva2:1479801/FULLTEXT01.pdf
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