[Assessing psychosomatic aspects of chronic orofacial pain syndrome]

The diagnosis of COS is often formulated when classification fails for the lack of clear symptoms or persisting complaints in spite of evidence-based dental care.

Eight patients suffering from COS and referred to us by the Dental Clinic of the Munich University were invited to complete the self-rating SASB-Intrex questionnaire. In addition, the patients were examined in a clinical psychodynamic interview.

All patients suffered from undefined, very often bizarre, complaints of the teeth, oral cavity, and face. These dysesthetic syndromes occurred after previous dental interventions. However, the complaints surpass symptomatic pain due to local aetiologies or neurological causes. There was clinical evidence of underlying unconscious conflicts, e. g., concerning control vs. submission. All patients showed clinically-relevant psychosomatic co-morbidity which could be formulated as cyclic maladaptive interpersonal patterns.

COS patients are often not sufficiently examined and undergo multiple, sometimes irreversible and invalidating dental or surgical interventions. Given their exclusively somatic attribution style, referral to psychotherapy is frequently unsuccessful. Characteristic cyclic maladaptive interaction patterns may contribute to the chronification process. This study shows the difficulties and chances of an interdisciplinary diagnosis and treatment program.