Keynote Address: Chronic Orofacial Pain: A Spread of Effect Enigma

Chronicity remains one of the least understood characteristics of every common chronic pain condition, including temporomandibular disorders, or TMD, easily the most common chronic orofacial pain condition and the most important from a public health perspective.  The hallmark that is one of the most enigmatic and central features of chronic pain conditions is that over time---and chronicity, per force, means "over time"-- the observable toll on the body reflected as pathobiology and the observable toll on the person  reflected as psychosocial disability associated with these chronic conditions is not equally distributed.  In the context of the prevalent biopsychosocial model used to study chronic orofacial, there is little evidence that the natural history or clinical course of TMD as historically studied is associated with significant physical disease progression over time.  Chronicity of TMD is not associated with deteriorating pathobiology, except in rare cases.  By marked contrast, for a significant number of TMD patients, chronic TMD is well known to be associated with significant personal suffering, including emotional upset and limitations in and interference with psychosocial function that adversely affects quality of life and increases the risk for iatrogenic complications, including those associated with substance abuse. This presentation will briefly review how chronicity of TMD has been studied and will dwell for the most part on current and emerging concepts and methods aimed both to bring better prediction and control over the factors that contribute to chronic TMD and that may also bring promise for minimizing--maybe even preventing its often devastating spread of effect into the lives of chronic TMD sufferers.