Tmj And Craniofacial Pain: Diagnosis And Management Mobi Download Book

While emotional/behavioral distress is quite common in various EDSs and significantly contribute to disability, the relevance of psychologic/psychiatric features and their likely relationships with the underlying pathophysiology are generally overlooked in the management of these patients. By studying 48 EDS patients (including eleven with a clinical diagnosis of EDS-HT and five with JHS), Lumley et al. detected a high rate of anxiety, depression, anger, and interpersonal concerns [110]. Interestingly, access to psychiatric services was registered in ~2/3 patients. A considerable excess of emotional symptoms [111] and psychological distress and somatosensory amplification [38] are noted in JHS/EDS-HT patients. More specifically, JHS/EDS-HT is more common among patients suffering from anxiety and panic disorders and, in turn, these complaints are frequently reported in JHS/EDS-HT [112, 113]. Although psychological difficulties may be secondary to chronic pain and disability, ostracism, and avoidance of relationships, a primary (i.e., pleiotropic) and/or organic contributor may coexist. Accordingly, Eccles et al. described greater amygdale volumes in reportedly hypermobile compared with nonhypermobile subjects [114]. Additional findings included decreased volume of anterior cingulate and parietal lobe. Volumetrically abnormal regions are implicated in cognitive control of pain and negative emotions [115]. It is well known that behavior is influenced by the environment, via neural afferents, as an adaptive reply to the homeostatic need. Reactive behavior changes induce, in turn, autonomic arousal states which translate in action such a reply. Therefore, in JHS/EDS-HT, it is possible that, in the future, some behavioral/psychological characteristics could be unexpectedly linked to specific functional features, such as dysautonomia and lack of proprioception. 2b1af7f3a8