Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions

Alfonso Gil-Martínez, Alba Paris-Alemany, Ibai López-de-Uralde-Villanueva, Roy La Touche, Alfonso Gil-Martínez, Alba Paris-Alemany, Ibai López-de-Uralde-Villanueva, Roy La Touche

Abstract

Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild-moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.

Keywords: biobehavioral; biobehavioral orofacial pain; disability; motor behavior; multimodal approach; review; temporomandibular disorders.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The four dimensions of the biobehavioral model of pain perception and motor behavior. Notes: The four circle segments are variables for assessment and treatment according to each dimension. Outside boxes are transverse or aspecific variables that are dependent on interactions among the different dimensions.
Figure 2
Figure 2
Mechanisms involved in the biobehavioral model of pain perception and motor behavior. Notes: Generation of pain perception from somatosensory or emotional stimuli or the combination of both according to different contexts can influence increased or decreased pain perception. The black boxes show the cognitive processes involved in the maintenance and “chronification” of symptoms from behavioral changes, emphasizing those related to motor behavior that in turn can influence feedback and learning for the maintenance of pain perception and increase perceived disability.
Figure 3
Figure 3
Representation of the therapeutic approach according to the biobehavioral model of pain perception and motor behavior. Notes: An essential objective within the model is the reduction of the disability. It is proposed that this objective can be approached from the achievement of two secondary objectives: reduction in perception of pain, and improvement in motor behavior. It is a biobehavioral therapeutic structure based on diverse treatment methods that influence the four dimensions raised in the model.

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