Behavioral and educational modalities.

Abstract

General agreement has emerged in the scientific literature that behavioral and educational modalities are useful and effective in the management of chronic pain conditions. Behavioral and educational treatment modalities constitute a component of virtually every established chronic pain treatment program. It has been demonstrated that management of temporomandibular disorders has benefited from such behavioral interventions as well. The label "biobehavioral" refers to proven, safe methods that emphasize self-management and acquisition of self-control over not only pain symptoms but also their cognitive attributions or meanings and maintaining a productive level of psychosocial function, even if pain is not totally absent. A large collection of treatment modalities is subsumed under the label of biobehavioral treatments; the most commonly studied of these include biofeedback, stress management, relaxation, hypnosis, and education. An NIH Technology and Assessment Conference held in 1995 comprises the best available summary of the state of the art concerning the suitability of biobehavioral methods as useful approaches to ameliorate chronic pain, including TMD. Educational methods have also been demonstrated to be efficacious in the self-management of headache and back pain, but only limited data are available for TMD. By and large, when biobehavioral treatments are used in the management of TMD, effects are virtually always positive and in the hypothesized beneficial direction. While effects are often moderate in size, these methods show the potential for producing long-lasting benefits when compared with usual clinical treatment for TMD. Research has as yet failed to establish one biobehavioral modality as superior to another. It is important to note that much the same situation is present with regard to the scientifically established validity of many biomedically based TMD treatments.