Challenges in the clinical implementation of a biopsychosocial model for assessment and management of orofacial pain

Abstract

Distress, suffering and care‐seeking behaviour are characteristics of pain‐related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high‐impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro‐facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis‐II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels‐of‐care settings, (3) health services, (4) cross‐cultural validity of self‐report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi‐axial assessment protocols is under‐rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence‐based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.

Field-testing a psychosocial assessment scoring form for TMD patients - summarizing axis II instruments

“…In daily dental practice, a red flag could led to referral to an expert for TMD or orofacial pain. Moreover, the psychosocial scoring assessment form can be beneficial for the diagnosis of other chronic pain conditions in the orofacial region, such as occlusal dysesthesia or burning mouth syndrome [ 27 , 28 ]. However, as psychosocial education is not only important in dental education, it should be a major focus in other disciplines, since psychosocial characteristics have a high impact in, e.g., lower back pain, Parkinson’s disease, or cardiovascular diseases [ 29 – 31 ].…”

New International Classification of Orofacial Pain: What Is in It For Endodontists?

“…The endodontist who is not familiar with diagnosing non-odontogenic etiologies for "toothache" complaints, which is common in endodontic practice (8,25), is provided a way to at least categorize the etiology for their patient's pain complaint and a clue to how best to manage them, such as identifying the appropriate provider to refer to. Furthermore, the inclusion of Chapter 7, which deals with psychosocial assessment, helps guide the dentist in taking these important factors into consideration diagnostically and management-wise since they are known to affect pain in general (26) and orofacial pains in specific (9,27).…”

Applying a General Systems Theory framework in Mental Health Treatment Pathways: the case of the Hellenic Center of Mental Health and Research

“…The most commonly used derivative of GST is the Biopsychosocial (BPS) model, which is commonly mentioned in mental health care (17,18) along with its criticism (19). However an actual operating framework based on GST is not actually put into perspective to interested stakeholders, as it was pointed out by Sharma et al (20), where they assessed the clinical implementation of BPS in temporomandibular and other orofacial pain conditions. Although evidence and information might be collected from across all of the three general BPS domains, these might not be comprehensive with regard to the individual BPS components, especially when cultural aspects and societal expectations are among the most in uential factors in mental health.…”