Self-report assessment of orofacial pain and psychosocial status

Substantial gains in the understanding of orofacial pain states such as temporomandibular disorder (TMD) have emerged from the inclusion of a biopsychosocial domain (Axis II) in the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). As one of the model systems for the physical (Axis I) and biopsychosocial assessment and classification of other pain disorders, the RDC/TMD recently underwent an evaluation and redesign. The Diagnostic Criteria for TMD (DC/TMD), the second-generation system, has retained the dual axis system with a view to the future development of a third axis, biomarkers, and a fourth axis, person classification. The plans for future development of the DC/TMD reflect the clinical importance and utility of formal multiaxial assessment of critical concepts and constructs, not only for TMD but for all orofacial pain conditions. For the other orofacial pain conditions, the need for developing an operationalized Axis I diagnostic system and a parallel Axis II assessment system is apparent. Most of the existing literature on orofacial chronic pain demonstrates that psychosocial factors represent particularly attractive targets for (adjunctive) intensive intervention in order to produce better outcomes and reduce associated morbidity. Moreover, recent advances in the understanding of pain-related neuroplastic changes demonstrate the value of psychosocially oriented interventions across multiple pain disorders, including persistent orofacial pain conditions. Therefore, a biopsychosocial assessment is warranted, no matter how simplistic or short, as a standard part of orofacial pain and TMD assessment. This chapter addresses the central role of self-report, including its validity as a surrogate index of what the brain is doing, and evaluates which domains are useful to assess in order to enrich the diagnostic understanding of the individual with orofacial pain. It then outlines a research agenda for how best to investigate and develop a broader Axis II for orofacial pain.