Manual de assistência em saúde mental para indivíduos com disfunção temporomandibular e dor orofacial: proposta baseada em revisão integrativa

Abstract

Introduction: Temporomandibular Dysfunction (TMD) and Orofacial Pain (OFP) affect a significant portion of the global population, causing a considerable impact on the daily activities of affected individuals, so that high levels of anxiety, stress, depression and chronic pain are closely related to these conditions. Thus, it is essential to understand the role of psychotherapeutic care, which aims to contribute to the reduction of the intensity of reported pain, since this approach allows directly dealing with the emotional components involved in the perception of pain and improving quality of life. Objective: To develop a manual aimed at health professionals regarding mental health care for individuals with TMD and OFP, based on the identification of the most effective treatment modalities in the psychotherapeutic approach of patients with temporomandibular dysfunction and orofacial pain through an integrative review of the literature Method: The research protocol followed an integrative review prior to the preparation of the manual, based on the guidelines proposed by the Joanna Briggs Institute (IJB) and its report made according to the international guide Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA), having been registered on the Open Science Framework (OSF) platform (2020) (https://osf.io/a7ych). The search strategy was carried out using the Health Science Descriptors (DeCS) and Medical Subject Headings (MeSH Terms): “Psychotherapy”, “Quality of Life”, “Temporomandibular Joint Dysfunction Syndrome” and “Facial Pain”. These descriptors were combined in a standardized manner, through Boolean logical operators (“And” and “Or”). This integrative review included randomized clinical trials, systematic reviews with or without meta-analysis that addressed the use of psychological care in the care/management of adult patients with TMD and OFP. Thus, the proposed manual, presented at the end, includes guidelines for Psychology professionals for the psychotherapeutic assistance of patients with TMD and OFP. Results: After reading the articles in full and selecting the eligibility criteria, 4 articles were eligible and were included in the qualitative synthesis of the study, guiding the fundamental information that was inserted in the manual. Therefore, the manual was divided into three parts: I - Chronic pain, TMD and PAIN, II - Mental health and psychological care and III - Psychotherapeutic care for patients with TMD and PAIN. Conclusions: Based on the construction of this manual, it can be inferred that interdisciplinarity is one of the pillars of TMD and OFP treatment. Therefore, professionals who treat pain must prepare themselves for a multidisciplinary interface that involves complex and dynamic management, with periodic reassessments of patients, with a focus on offering the best possibility of control or treatment for the patient, respecting their symptoms and individuality. Therefore, psychoemotional factors, such as anxiety, depression and stress, play a significant role in modulating pain and worsening TMD and OFP symptoms. In this context, psychological treatment, specifically cognitive-behavioral therapies, have proven to be an effective therapeutic tool, promoting reduction in pain intensity, functional improvement and relief of emotional suffering.