A biopsychological approach to temporomandibular joint pain and other chronic facial pain. Part II: Broadening of spectrum of treatments.

The multidimensional nature of chronic pain often requires a variety of therapies, ranging from reassurance and relaxation training to invasive treatment. The high spontaneous rate of recovery in temporomandibular dysfunction can lead to overtreatment of a benign disorder. However, a tendency to undertreat chronic facial pain and malignant pain conditions also exists. In therapy-resistant chronic pain cases, alternative therapies merit consideration, even though they may generally be rejected by Western medicine as unscientific and no better than placebo. Working with chronic pain patients is demanding and fulfilling but can be wearing. Doctors, nurses and other staff involved in pain treatment should take part in supervision of therapeutic work, to prevent burn-out. This article offers guidelines for treatments rarely considered as routine therapy, and describes an extreme case of therapy-resistant chronic facial pain.