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In summary, the biopsychosocial
model reflects our growing understanding that illnesses and
cures are indeed complex and interrelated. To understand how and
when we get sick, or whether or not we will respond to treatment,
a host of factors in addition to biologic processes must be considered.
The biopsychosocial
model does not seek to compete with, let alone replace, scientifically
derived biologic models or current clinical practices. Rather,
the model is an integrative one, which conceives that biologic
processes and environmental factors, in the broad sense, are equipotent
for explaining not only illness but also responses to treatment.
Thus, no health problem
is conceived of as either solely physical or mental--as simply
biologic or psychologic. Instead of trying to force a particular
patient onto one end or the other of a single psycho-versus-somatic
continuum, the current thinking suggests that at least two axes
be conceptualized (see Figure 2.2 below):
On one axis, each patient is located to reflect their physical
status, i.e. masticatory muscle disorders, TMJ disc derangements,
and inflammatory and degenerative TMJ disorders.
On a second axis, the subjective, symptomatic state of the
person is described, reflecting psychological, emotional, or
behavioral factor known to influence pain report and pain-related
behavior, i.e. pain severity, parafunctional jaw behaviors,
depression, somatization, and psychosocial function.
Figure
2.2 Biophysical Model
Domains for Treatment Interventions
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The implications for
research into treatment should be obvious, for if multiple physical
and psychosocial factors enter into the origin, exacerbation,
and maintenance of the expression of TMD (see Figure 2.2 above),
then exploration of effective treatments and more meaningful treatment
outcome measures should be expanded to reflect the role of these
multiple factors.
The interaction of
physical, behavioral, and psychosocial factors helps to explain
the diverse and often bewildering expression of TMD signs and
symptoms that clinicians observe. In addition, these multiple
factors allow paradoxical appearing responses to single vs. combined
treatment approaches and especially, to short- vs. long-term treatment
outcomes.
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