Psychology Rather Than Morphology

Letters to the editor Idiopathic Facial Pain Syndromes—an Overview and Clinical Implications by Dr. med. Christian Ziegeler, Prof. Dr. med. Dr. med. dent. Thomas Beikler, Prof. Dr. med. Dr. med. dent. Martin Gosau, Prof. Dr. med. Arne May in issue 6/2021

In the authors’ opinion (1) a uniform classification system for facial pain can improve the options for “adequate treatment.” The extremely differentiated nosology they introduced was, however, clinically and statistically of little help, with the result that the authors themselves used outdated and their own terminology. Persistent idiopathic facial pain (PIFP) was the most common affliction in the patients in their specialist outpatient clinic. It is called “idiopathic” because no morphological concept can explain the pain.

“Adequate” therapy for PIFP consists of avoiding invasive measures, medication (as in neuropathic pain), and psychotherapy. Psychotherapy aims to move the patient to accept their pain and not to have unrealistic expectations of success—a truly modest result of decades of pain medicine, in which, ultimately, increasing nosological differentiation faces therapeutic de-differentiation. The reason for this is likely to be a disease theory that is based only on morphology and symptomatology. According to our investigations (2), PIFP is a pain disorder affecting the oral region (3), which can be explained by looking at a patient’s life history and psychodynamic development (which means it is absolutely not idiopathic), which should be diagnosed and treated according to the biopsychosocial model (4). The cause of this form of facial pain should not be sought in biological-structural pathology but in the patient’s psyche.

DOI: 10.3238/arztebl.m2021.0208

Dr. med. Otmar Seidl

Klinik und Poliklinik für Psychiatrie und Psychotherapie

Sektion für Psychosomatische Medizin und Psychotherapie

LMU Klinikum München

References

1. Ziegeler C, Beikler T, Gosau M, May A: Idiopathic facial pain syndromes—an overview and clinical implications. Dtsch Arztebl Int 2021; 118: 81–7

2. Seidl F, Frick E: Untersuchungen zur Psychodynamik der chronischen Orofazialen Schmerzstörung. Z Psychosom Med Psychother 2021 (in press).

3. Sergl HG: Der Erlebnisraum Mund. In: Sergl HG (eds.): Psychologie und Psychosomatik in der Zahnheilkunde. München: Urban & Schwarzenberg 1995; 1–9.

4. Sharma S, Breckons M, Brönnimann Lambelet B, et al.: Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain. J Oral Rehabil 2020; 47: 87–100