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Biopsychosocial Aspects of Orofacial Pain

Abstract

This chapter introduces the reader to the important concept of the biopsychosocial model of illness and its role in healthcare. The chapter explains the theoretical basis of the biopsychosocial model and its relevance to an integrated understanding of pain. Practical application in assessing patients for psychosocial comorbidity and providing appropriate interventions through the use of psychosocial interventions including basic clinical practices informed by cognitive behavioral therapies are described.

Keywords

  • Orofacial pain
  • Temporomandibular disorders
  • Biopsychosocial model
  • Diagnosis
  • Treatment

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References

  • Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med. 2000;160(2):221–7.

    CrossRef  PubMed  Google Scholar 

  • Aggarwal VR, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ. The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol. 2006;35(2):468–76.

    CrossRef  PubMed  Google Scholar 

  • Aggarwal VR, McBeth J, Zakrzewska JM, Macfarlane GJ. Unexplained orofacial pain – is an early diagnosis possible? Br Dent J. 2008;205(E6):1–6. DOI: 10.1038/sj.bdj.2008.585.

    Google Scholar 

  • Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management of chronic orofacial pain. The Cochrane Library. 2008;205(E6):1–6.

    Google Scholar 

  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Fifth ed. Arlington: American Psychiatric Association; 2013.

    Google Scholar 

  • Annandale T. Displacement of the inter-articular cartilage of the lower jaw, and its treatment by operation. Lancet. 1887;129:411.

    CrossRef  Google Scholar 

  • Apkarian AV, Bushnell MC, Treede R-D, Zubieta J-K. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005;9(4):463–84.

    CrossRef  PubMed  Google Scholar 

  • Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003;16(2):131–47.

    CrossRef  PubMed  Google Scholar 

  • Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191.

    CrossRef  PubMed  Google Scholar 

  • Bell WE. Orofacial pains: differential diagnosis. 2nd ed. Chicago: Year Book Medical Publishers; 1979.

    Google Scholar 

  • Boersma K, Linton SJ. Expectancy, fear and pain in the prediction of chronic pain and disability: a prospective analysis. Eur J Pain: EJP. 2006;10(6):551–7.

    CrossRef  PubMed  Google Scholar 

  • Brister H, Turner JA, Aaron LA, Mancl L. Self-efficacy is associated wtih pain, functioning, and coping in patients with chronic temporomandibular disorder pain. J Orofac Pain. 2006;20:115–24.

    PubMed  Google Scholar 

  • Bury M. Chronic illness as biographical disruption. Sociol Health Illn. 1982;4(2):167–82.

    CrossRef  PubMed  Google Scholar 

  • Campbell CM, Edwards RR. Mind–body interactions in pain: the neurophysiology of anxious and catastrophic pain-related thoughts. Transl Res. 2009;153(3):97–101.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Carlsson GE, Egermark I, Magnusson T. Predictors of bruxism, other oral parafunctions, and tooth wear over a 20-year follow-up period. J Orofac Pain. 2003;17(1):50–7.

    PubMed  Google Scholar 

  • Ceusters W, Michelotti A, Raphael KG, Durham J, Ohrbach R. Perspectives on next steps in classification of oro-facial pain – part 1: role of ontology. J Oral Rehabil. 2015;42:926–41.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Cimpean D, Drake R. Treating co-morbid chronic medical conditions and anxiety/depression. Epidemiol Psychiatr Sci. 2011;20(02):141–50.

    CrossRef  PubMed  Google Scholar 

  • Cioffi I, Michelotti A, Perrotta S, Chiodini P, Ohrbach R. Effect of somatosensory amplification and trait anxiety on experimentally induced orthodontic pain. Eur J Oral Sci. 2016;124(2):127–34.

    CrossRef  PubMed  Google Scholar 

  • Costen JB. A syndrome of ear and sinus symptoms dependent upon disturbed function of the temporomandibular joint. Ann Otol Rhino Laryngol. 1934;43:1–15.

    CrossRef  Google Scholar 

  • Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3(8):655–66.

    CrossRef  PubMed  Google Scholar 

  • Craig AD. A new view of pain as a homeostatic emotion. Trends Neurosci. 2003;26(6):303–7.

    CrossRef  PubMed  Google Scholar 

  • Durham J, Ohrbach R. Commentary on disability and dental education. J Oral Rehabil. 2010;37(6):490–4.

    CrossRef  PubMed  Google Scholar 

  • Durham J, Steele J, Wassell R, Exley C. Living with uncertainty: temporomandibular disorders. J Dent Res. 2010;89(8):827–30.

    CrossRef  PubMed  Google Scholar 

  • Durham J, Steele J, Moufti M, Wassell R, Robinson P, Exley C. Temporomandibular disorder patients’ journey through care. Community Dent Oral Epidemiol. 2011;39(6):532–41.

    CrossRef  PubMed  Google Scholar 

  • Durham J, Raphael KG, Benoliel R, Ceusters W, Michelotti A, Ohrbach R. Perspectives on next steps in classification of oro-facial pain – part 2: role of psychosocial factors. J Oral Rehabil. 2015;42(12):942–55.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Durham J, Shen J, Breckons M, Steele J, Araujo-Soares V, Exley C, et al. Healthcare cost and impact of persistent orofacial pain: the DEEP Study cohort. J Dent Res. 2016;95(10):1147–54.

    CrossRef  PubMed  Google Scholar 

  • Dworkin SF. Research diagnostic criteria for temporomandibular disorders: current status and future relevance. J Oral Rehabil. 2010;37:734–43.

    CrossRef  PubMed  Google Scholar 

  • Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J. Craniomandib Disord Facial Oral Pain. 1992;6(4):301–55.

    Google Scholar 

  • Dworkin SF, Huggins KH, Wilson L, Mancl L, Turner J, Massoth D, et al. A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program. J Orofac Pain. 2002;16:48–63.

    PubMed  Google Scholar 

  • Eisenberg L. Disease and illness. Distinctions between professional and popular ideas of sickness. Cult Med Psychiatry. 1977;1(1):9–23.

    CrossRef  PubMed  Google Scholar 

  • Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–36.

    CrossRef  PubMed  Google Scholar 

  • Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry. 1980;137(5):535–44.

    CrossRef  PubMed  Google Scholar 

  • Engel GL. Misapplication of a scientific paradigm. Integr Psychiatry. 1985;3:9–11.

    Google Scholar 

  • Epker J, Gatchel RJ, Ellis EI. A model for predicting chronic TMD: practical application in clinical settings. JADA. 1999;130:1470–5.

    PubMed  Google Scholar 

  • Escobar JI, Waitzkin H, Silver RC, Gara M, Holman A. Abridged somatization: a study in primary care. Psychosom Med. 1998;60(4):466–72.

    CrossRef  PubMed  Google Scholar 

  • Farb N, Daubenmier JJ, Price CJ, Gard T, Kerr C, Dunn B, et al. Interoception, contemplative practice, and health. Front Psychol. 2015;6:763.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Fillingim RB, Ohrbach R, Greenspan JD, Knott C, Dubner R, Bair E, et al. Potential psychosocial risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 2011;12(11 (supplement 3)):T46–60.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Garofalo JP, Gatchel RJ, Wesley AL, Ellis EI. Predicting chronicity in acute temporomandibular joint disorders using the research diagnostic criteria. JADA. 1998;129:438–47.

    PubMed  Google Scholar 

  • Gatchel RJ, Okifuji A. Evidence-based scientific data documenting the treatment and cost-effectiveness of comprehensive pain programs for chronic nonmalignant pain. J Pain. 2006;7(11):779–93.

    CrossRef  PubMed  Google Scholar 

  • Gatchel RJ, Stowell AW, Buschang P. The relationships among depression, pain, and masticatory functioning in temporomandibular disorder patients. J Orofac Pain. 2006;20(4):288–96.

    PubMed  Google Scholar 

  • Glaros AG, Burton E. Parafunctional clenching, pain, and effort in temporomandibular disorders. J Behav Med. 2004;27(1):91–100.

    CrossRef  PubMed  Google Scholar 

  • Glaros AG, Williams K. Tooth contact versus clenching: oral parafunctions and facial pain. J Orofac Pain. 2012;26(3):176–80.

    PubMed  Google Scholar 

  • Glaros A, Marszalek J, Williams K. Longitudinal multilevel modeling of facial pain, muscle tension, and stress. J Dent Res. 2016;95(4):416–22.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Greene CS. Managing the care of patient with temporomandibular disorders: a new guideline for care. JADA. 2010;141(9):1086–8.

    PubMed  Google Scholar 

  • Greene CS, Laskin DM. Long-term evaluation of conservative treatment for myofascial pain-dysfunction syndrome. JADA. 1974;69:1365–8.

    Google Scholar 

  • Greene CS, Obrez A. Treating temporomandibular disorders with permanent mandibular repositioning: is it medically necessary? Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(5):489–98.

    CrossRef  PubMed  Google Scholar 

  • Greene CS, Mohl ND, McNeill C, Clark GT, Truelove EL. Temporomandibular disorders and science: a response to the critics. J Prosthet Dent. 1998;80:214–5.

    CrossRef  PubMed  Google Scholar 

  • Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. J Behav Med. 1985;8:163–90.

    CrossRef  PubMed  Google Scholar 

  • Kanaan RA, Lepine JP, Wessely SC. The association or otherwise of the functional somatic syndromes. Psychosom Med. 2007;69(9):855–9.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Kaplan SEF, Ohrbach R. Self-report of waking-state oral parafunctional behaviors in the natural environment. J Oral Facial Pain Headache. 2016;30:107–19.

    CrossRef  PubMed  Google Scholar 

  • Kirmayer LJ, Robbins JM. Functional somatic syndromes. In: Kirmayer LJ, Robbins JM, editors. Current concepts of somatization: research and clinical perspectives. Washington, DC: American Psychiatric Press; 1991. p. 79–106.

    Google Scholar 

  • Kori SH, Miller RP, Todd DD. Kinesiophobia: a new view of chronic pain behavior. Pain Manag. 1990;3:35–43.

    Google Scholar 

  • Kotiranta U, Suvinen T, Kauko T, Le Bell Y, Kemppainen P, Suni J, et al. Subtyping patients with temporomandibular disorders in a primary health care setting on the basis of the research diagnostic criteria for temporomandibular disorders axis II pain-related disability: a step toward tailored treatment planning? J Oral Facial Pain Headache. 2015;29(2):126–34.

    CrossRef  PubMed  Google Scholar 

  • Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.

    CrossRef  PubMed  Google Scholar 

  • Kroenke K, Spitzer RL, Williams JB, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4):345–59.

    CrossRef  PubMed  Google Scholar 

  • Laskin DM. Myofascial pain-dysfunction syndrome: etiology. In: Sarnat BG, Laskin DM, editors. The temporomandibular joint a biological basis for clinical practice. 3rd ed. Springfield: Charles C. Thomas; 1979. p. 289–99.

    Google Scholar 

  • Litt MD, Porto FB. Determinants of Pain Treatment Response and Nonresponse: Identification of TMD Patient Subgroups. The Journal of Pain. 2013;14(11):1502–13. doi: 10.1016/j.jpain.2013.07.017.

    Google Scholar 

  • Lorduy KM, Liegey-Dougall A, Haggard R, Sanders CN, Gatchel RJ. The prevalence of comorbid symptoms of central sensitization syndrome among three different groups of temporomandibular disorder patients. Pain Pract. 2013;13(8):604–13.

    CrossRef  PubMed  Google Scholar 

  • Löwe B, Kroenke K, Grafe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163–71.

    CrossRef  PubMed  Google Scholar 

  • Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, et al. A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionaire-4 in the general population. J Affect Disord. 2010;122(1–2):86–95.

    CrossRef  PubMed  Google Scholar 

  • Manfredini D, Favero L, Gregorini G, Cocilovo F, Guarda-Nardini L. Natural course of temporomandibular disorders with low pain-related impairment: a 2-to-3-year follow-up study. J Oral Rehabil. 2013;40(6):436–42.

    CrossRef  PubMed  Google Scholar 

  • Markiewicz MR, Ohrbach R, McCall Jr WD. Oral behaviors checklist: reliability of performance in targeted waking-state behaviors. J Orofac Pain. 2006;20(4):306–16.

    PubMed  Google Scholar 

  • Melis M, Zawawi KH. Occlusal dysesthesia: a topical narrative review. J Oral Rehabil. 2015;42(10):779–85.

    CrossRef  PubMed  Google Scholar 

  • Michelotti A, Alstergren P, Goulet JP, Lobbezoo F, Ohrbach R, Peck C, et al. Next steps in development of the diagnostic criteria for temporomandibular disorders (DC/TMD): recommendations from the International RDC/TMD Consortium Network workshop. J Oral Rehabil. 2016;43(6):453–67. ePrint

    CrossRef  PubMed  Google Scholar 

  • NIH. NIH technology assessment conference on integration of Behavioral and relaxation approaches into the treatment of chronic pain and insomnia. Bethesda: National Institutes of Health; 1995.

    Google Scholar 

  • Nixdorf DR, Drangsholt MT, Ettlin DA, Gaul C, de Leeuw R, Svensson P, et al. Classifying orofacial pains: a new proposal of taxonomy based on ontology. J Oral Rehabil. 2012;39(3):161–9.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R. Disability assessment in temporomandibular disorders and masticatory system rehabilitation. J Oral Rehabil. 2010;37:452–80.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R, Dworkin SF. Longitudinal changes in TMD: relationship of changes in pain to changes in clinical and psychological variables. Pain. 1998;74:315–26.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. J Dent Res. 2016;95(10):1093–101.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R, Greene C. Temporomandibular joint diagnosis: striking a balance between the sufficiency of clinical assessment and the need for imaging. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013;116(1):124–5.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R, Granger CV, List T, Dworkin SF. Pain-related functional limitation of the jaw: preliminary development and validation of the jaw functional limitation scale. Community Dent Oral Epidemiol. 2008a;36:228–36.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R, Larsson P, List T. The jaw functional limitation scale: development, reliability, and validity of 8-item and 20-item versions. J Orofac Pain. 2008b;22:219–30.

    PubMed  Google Scholar 

  • Ohrbach R, Markiewicz MR, McCall Jr WD. Waking-state oral parafunctional behaviors: specificity and validity as assessed by electromyography. Eur J Oral Sci. 2008c;116(5):438–44.

    CrossRef  PubMed  Google Scholar 

  • Ohrbach R, Fillingim RB, Mulkey F, Gonzalez Y, Gordon S, Gremillion H, et al. Clinical findings and pain symptoms as potential risk factors for chronic TMD: descriptive data and empirically identified domains from the OPPERA case-control study. J Pain. 2011;12(11, Supplement 3):T27–45.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Ohrbach R, Bair E, Fillingim RB, Gonzalez Y, Gordon SM, Lim PF, et al. Clinical orofacial characteristics associated with risk of first-onset TMD: the OPPERA prospective cohort study. J Pain. 2013;14(12, Supplement 2):T33–50.

    CrossRef  PubMed  Google Scholar 

  • Padesky CA, Mooney KA. Presenting the cognitive model to clients. International Cognitive Therapy Newsletter. 1990:6:13–14. Retrieved from www.padesky.com.

  • Parsons T. The sick role and the role of the physician reconsidered. Milbank Mem Fund Q Health Soc. 1975;53(3):257–78.

    CrossRef  PubMed  Google Scholar 

  • Peters S, Goldthorpe J, McElroy C, King E, Javidi H, Tickle M, et al. Managing chronic orofacial pain: a qualitative study of patients’, doctors’, and dentists' experiences. Br J Health Psychol. 2015;20(4):777–91.

    CrossRef  PubMed  Google Scholar 

  • Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother. 2009;9(5):745–58.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Rief W, Broadbent E. Explaining medically unexplained symptoms-models and mechanisms. Clin Psychol Rev. 2007;27(7):821–41.

    CrossRef  PubMed  Google Scholar 

  • Robinson ME, Wise EA, Gagnon C, Fillingim RB, Price DD. Influences of gender role and anxiety on sex differences in temporal summation of pain. J Pain. 2004;5:77–82.

    CrossRef  PubMed  Google Scholar 

  • Sage N, Sowden M, Chorlton E, Edeleanu A. CBT for chronic illness and palliative care: a workbook and toolkit. Chichester: Wiley; 2013.

    Google Scholar 

  • Sanders AE, Slade GD, Bair E, Fillingim RB, Knott C, Dubner R, et al. General health status and incidence of first-onset temporomandibular disorder: the OPPERA prospective cohort study. J Pain. 2013;14(12 Suppl):T51–62.

    CrossRef  PubMed  Google Scholar 

  • Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014;28(1):6–27.

    CrossRef  PubMed  PubMed Central  Google Scholar 

  • Schwartz LL. Pain associated with the temporomandibular joint. JADA. 1955;4:393–7.

    Google Scholar 

  • Spitzer RL, Kroenke K, Williams JBW. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282:1737–44.

    CrossRef  PubMed  Google Scholar 

  • Suvinen TI, Reade PC, Hanes KR, Kononen M, Kemppainen P. Temporomandibular disorder subtypes according to self-reported physical and psychosocial variables in female patients: a re-evaluation. J Oral Rehabil. 2005;32(3):166–73.

    CrossRef  PubMed  Google Scholar 

  • Teasdale JD, Segal Z, Williams JMG. How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behav Res Ther. 1995;33:25–39.

    CrossRef  PubMed  Google Scholar 

  • Turner JA, Mancl L, Aaron LA. Brief cognitive-behavioral therapy for temporomandibular disorder pain: effects on daily electronic outcome and process measures. Pain. 2005;117:377–87.

    CrossRef  PubMed  Google Scholar 

  • Turner JA, Mancl L, Aaron LA. Short- and long-term efficacy of brief cognitive-behavioral therapy for patients with chronic temporomandibular disorder pain: a randomized, controlled trial. Pain. 2006;121(3):181–94.

    CrossRef  PubMed  Google Scholar 

  • Turner JA, Holtzman S, Mancl L. Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain. 2007;127(3):276–86.

    CrossRef  PubMed  Google Scholar 

  • Visscher CM, Ohrbach R, van Wijk AJ, Wilkosz M, Naeije M. The Tampa scale for kinesiophobia for temporomandibular disorders (TSK-TMD). Pain. 2010;150:492–500.

    CrossRef  PubMed  Google Scholar 

  • Vlaeyen JWS, Linton SJ. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.

    CrossRef  PubMed  Google Scholar 

  • Von Korff M, Dunn KM. Chronic pain reconsidered. Pain. 2008;138(2):267–76.

    CrossRef  Google Scholar 

  • Wall PD. On the relation of injury to pain. Pain. 1979;6:253–64.

    CrossRef  PubMed  Google Scholar 

  • Wasan AD, Davar G, Jamison R. The association between negative affect and opioid analgesia in patients with discogenic low back pain. Pain. 2005;117:450–61.

    CrossRef  PubMed  Google Scholar 

  • Zulman DM, Shah NH, Verghese A. Evolutionary pressures on the electronic health record: caring for complexity. JAMA. 2016;316(9):923–4.

    CrossRef  PubMed  Google Scholar 

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Ohrbach, R., Durham, J. (2017). Biopsychosocial Aspects of Orofacial Pain. In: Farah, C., Balasubramaniam, R., McCullough, M. (eds) Contemporary Oral Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-28100-1_37-1

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