Epidemiologic Studies of Chronic Pain: A Dynamic-Ecologic Perspective

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Abstract
Three perspectives of epidemiology—population, developmental and ecological—are integrated by the biobehavioral model of chronic pain, providing a rationale and schema for epidemiologic pain research. This model suggests that physiologic, psychologic, and social factors interact in different ways at different stages in the development of pain and pain dysfunction, resulting in large variability in pain experience and behaviors for the same persons across time. One implication of the model is that augmentation of pain perception, appraisal and behavior, and changes in pain mechanisms as chronic pain develops may, in part, explain responses disproportionate to the extent of noxious stimulation and tissue damage. This review focuses on epidemiologic and relevant clinical studies of temporomandibular disorder (TMD) pain to consider potential contributions of epidemiology to chronic pain research. The findings reviewed in this article suggest that no single factor in isolation—pathophysiologic, psychologic, or social—will adequately explain chronic pain status. Variability in the expression of pain across time and the interaction of biologic, psychologic, and social factors in the development of pain and pain dysfunction require dynamic and multilevel ecologic concepts. Critical issues for future epidemiologic research in chronic pain and associated dysfunction are identified.

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