Biopsychosocial solutions to TMD.

is often followed by the development of postural abnormalities of the spine, either as a result of drastically reduced activities or as a maladaptive — and deliberate — measure for relieving pain. It has also been demonstrated that healthy subjects who assume postural abnormalities every day will ultimately generate neck and back pain, albeit minor. It has therefore been proposed, and studies are currently reaffirming this position, that one of the many physical sources for chronic neck pain in whiplash patients is the development of postural abnormalities even long after the acute injury has resolved. Thus, we have a truly physical source for pain, not at all psychiatric in origin, nor the result of the somatic component of anxiety. Yet what led to those postural abnormalities? In whiplash patients, studies indicate that the cultural factors responsible for symptom expectation, amplification and attri-bution produce a behaviour that leads to withdrawal from activities following minor injury and maladaptive postures. 7 Psychosocial factors ultimately generate a physical source for pain. That is a biopsychosocial model. Interestingly, there has been some investigation regarding the etiologic role of postural factors in some aspect of chronic TMD symptoms. 11,12 Psychosocial factors affect chronic neck pain in other ways, by drawing on pre-accident and post-accident aches and pains that arise from daily life, occupations, etc., many of which are presumed in otherwise healthy people to have physical sources, even though we can seldom identify those sources. These symptoms are usually minor, even if felt daily, and seldom cause much distress or disability. Yet, in the model proposed of the late whiplash syndrome, psychosocial factors compound the effect of physical symptoms to produce more severe — and apparently new — symptoms that are attributed to one cause. Thus, the sources of pain remain physical in origin, but the severity and attribution of the pain, as well as further behaviour in response to the pain, are determined by psychosocial factors. Such a model provides new approaches to treatment and truly reaffirms for the patient that the pain is not due to psychological factors. 13 The treatment is not " cognitive or behav-ioural therapy, " which implies therapy aimed at " psychological disorder. " Rather it is physical therapy (e.g., progressive exercises and posture correction/maintenance measures) which prevents behaviour that allows psychosocial factors to foster chronic pain. It is really biopsychosocial therapy. The patient is not told that the pain …