We would like to thank Dr. Gilligan for his comments. We all wish there were a relatively simple cause-and-effect basis for all TMDs. Unfortunately, that is not the case.
Dr. Gilligan is indeed fortunate that most TMD patients in his practice require little beyond equilibration and/or orthodontics. Based on the literature, approximately 80 percent of patients with TMD will receive roughly 80 percent improvement in their symptoms, regardless what treatment is rendered.
The literature also indicates that there are a certain percentage of patients who do not seemed to be "cured" no matter what the treatment. These "chronic" patients are the ones who give clinicians great difficulty and also give patients with TMD disrespectful categorizations.
It is well-established that many chronic pain disorders have huge psychological overlays. In this sense, TMDs are very similar to other chronic disorders such as low-back pain.
Indeed, the term "biopsychosocial" is the common term used in the pain literature to emphasize the often complex interaction of pathophysiological, psychological and social factors that need to be addressed in better understanding and treating chronic pain disorders such as TMD.
Managing the psychosocial components of their maladies can be just as effective as using other types of intervention. Combining biobehavioral interventions with conventional treatments often improves outcomes for patients with longstanding pain disorders beyond what can usually be achieved.
If therefore, such individuals who are susceptible to chronicity could be identified early in the acute state and then provided treatment that can help prevent them from becoming chronic, they would be better off.
That is the major, empirical issue being raised on the basis of the results of our study. Whether or not early biobehavioral intervention is beneficial for this purpose is something that is under investigation at our university.
