BEHAVIORAL AND EDUCATIONAL MODALITIES

General agreement has emerged in the scientific literature that behavi oral and educational modalities are useful and effective in the manage ment of chronic pain conditions. Behavioral and educational treatment modalities constitute a component of virtually every established chron ic pain treatment program. It has been demonstrated that management of temporomandibular disorders has benefited from such behavioral interv entions as well. The label ''biobehavioral'' refers to proven, safe me thods that emphasize self-management and acquisition of self-control o ver not only pain symptoms but also their cognitive attributions or me anings and maintaining a productive level of psychosocial function, ev en if pain is not totally absent. A large collection of treatment moda lities is subsumed under the label of biobehavioral treatments; the mo st commonly studied of these include biofeedback, stress management, r elaxation, hypnosis, and education. An NIH Technology and Assessment C onference held in 1995 comprises the best available summary of the sta te of the art concerning the suitability of biobehavioral methods as u seful approaches to ameliorate chronic pain, including TMD. Educationa l methods have also been demonstrated to be efficacious in the self-ma nagement of headache and back pain, but only limited data are availabl e for TMD. By and large, when biobehavioral treatments are used in the management of TMD, effects are virtually always positive and in the h ypothesized beneficial direction. While effects are often moderate in size, these methods show the potential for producing long-lasting bene fits when compared with usual clinical treatment for TMD. Research has as yet failed to establish one biobehavioral modality as superior to another. It is important to note that much the same situation is prese nt with regard to the scientifically established validity of many biom edically based TMD treatments.