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TMD may be viewed
as a complex, chronic pain condition with multiple contributing
factors that include among them (Epker
and Gatchel, 2000):
- The state of the
physical structures such as the masticatory muscles, teeth,
and the temporomandibular joint;
- Personal oral parafunctional
behaviors such as bruxism or clenching;
- Psychological
status, including anxiety, depression, somatization, and psychosocial
functioning;
- Ability to work;
- Use of medications;
and
- Treatment seeking.
According to this conceptualization,
TMD is currently best described by using a biopsychosocial
model for this condition.
The most relevant factors
in this biopsychosocial model of chronic pain relate to the view
that TMD is a chronic, fluctuating condition that is predominately
manifested by the report of pain. It is pain that overwhelmingly
drives people to seek TMD treatment, and it is pain that is the
principal outcome measure by which treatment is viewed as successful
or not, as evaluated by both the patient and by TMD health care
providers. Whether the cause of pain is from physical trauma or
an upset of normal physiologic processes from daily stressors,
either can generate subjective symptoms of pain and discomfort
anywhere in the body.
Other chapters in this
textbook dealing with symptomatic conditions for which people
seek treatment, such as irritable bowel syndrome, are further
examples of conditions that have been informed by the biopsychosocial
perspective (see Chapter
16, by Kroenke and Gale, Somatization and Symptom Evaluation,
this volume).
Chronic conditions
are, by definition, resistant to "cure" in the usual
sense of permanent elimination of signs and symptoms. The general
understanding has emerged that an alternative, rehabilitation
approach is more suitable for the design and implementation of
treatment management interventions (Gallagher,
1999). Such a rehabilitative approach is universally understood
to be central to the management of all chronic conditions in which
persistent pain is a critical factor, including tension headache,
common back pain, fibromyalgia, and irritable bowel syndrome.
In contrast, with a
curative approach, an outcome to confirm the usefulness of a treatment
intervention might be permanent elimination and reversal of all
signs and symptoms. Considering well-known examples from dentistry,
surgical extraction of an abscessed tooth "cures" a
single manifestation of toothache pain and underlying pathologic
infection.
On the other hand,
periodontal surgery, per se, is not viewed as an absolute cure
for much of periodontal disease, an acknowledged chronic dental
disease which requires a more complex disease and illness model
that integrates several treatment modalities--surgery, medication,
behavior change-to rehabilitate and then maintain the health of
the involved periodontal structures. As such, periodontal disease
is also best described by a biopsychosocial model.
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