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A biopsychosocial
model to aid in the design of research into TMD has been developed
(Dworkin et al., 1992).
Figure
2.1 Biobehavioral Model of Pain
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As illustrated in Figure
2.1 above, this model shows:
- Physical changes
altering physiologic processes -- whether from trauma, infection,
inflammation, genetic error, or developmental disability - can
give rise to signals transmitted via nociceptive pathways.
- Such nociceptive
signals come to the attention, or invoke, higher level information
processing systems of perception, appraisal, and initiation
of motor behavior.
- This occurs in the
context of the social milieu in which the person exists
and becomes defined as a patient.
It is through these
ongoing interactions between physical (e.g. pathophysiologic)
changes and the subjective awareness of them that symptoms emerge
into consciousness and behaviors are undertaken to eliminate or
ameliorate the aversive symptom state.
Thus, underlying the
pain as a symptom are complex neurologic and neurochemical processes
that yield nociceptive input to higher centers which, in turn,
are interpreted as pain. If persistent, observable chronic pain
behaviors emerge, including:
- Anxious
and depressive behaviors
- Reporting of multiple
symptom complaints including multiple pain complaints
- Avoidance of social
interaction
- Treatment and medication
seeking
As a chronic pain condition,
TMD is no exception to this clinical picture and abundant evidence
has established the presence of psychological distress and psychosocial
disability as well as increased health care utilization in important
segments of the TMD clinical population (Kight
et al., 1999; Dworkin and Suvinen,
1998).
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