Temporomandibular Myofascial Pain Syndrome—Aetiology and Biopsychosocial Modulation. A Narrative Review

This review elaborates on the aetiology, diagnosis, and treatment of temporomandibular (TMD) myofascial pain syndrome (MPS) regulated by psychosocial factors. MPS impairs functioning in society due to the accompanying pain. Directed and self-directed biopsychosocial profile modulation may be beneficial in the treatment of MPS. Moreover, nutrition is also a considerable part of musculoskeletal system health. A fruit and vegetable diet contributes to a reduction in chronic pain intensity because of its anti-inflammatory influence. Cannabidiol (CBD) oils may also be used in the treatment as they reduce stress and anxiety. A promising alternative treatment may be craniosacral therapy which uses gentle fascia palpation techniques to decrease sympathetic arousal by regulating body rhythms and release fascial restrictions between the cranium and sacrum. MPS is affected by the combined action of the limbic, autonomic, endocrine, somatic, nociceptive, and immune systems. Therefore, the treatment of MPS should be deliberated holistically as it is a complex disorder.

A Disruption in the Balance of Attentional Systems Plays a Role in Trait Anxiety

Elevated levels of anxiety are associated with attentional threat biases and inefficient attentional control, with the latter requiring sustained cognitive effort. The current study assessed self-reported and behavioral evidence of attentional functioning, along with electrodermal activity (EDA; measured via changes in skin conductance level [SCL reactivity]) as an index of sympathetic arousal, to examine whether these vulnerabilities are evident among individuals with elevated trait anxiety (non-clinical). Fifty-nine participants completed a working memory span task measuring attentional control under high cognitive load. A visual change detection task assessed stimulus-driven attention as an indicator of vigilance to non-threatening visual information. Trait anxiety was self-reported. SCL was captured at rest and during the working memory task. Results revealed that trait anxiety was positively related to speed of visual change detection, without accuracy costs, suggesting enhanced vigilance for neutral visual information among those higher in trait anxiety. Trait anxiety also moderated the relation between change detection speed and attentional control, such that attentional vigilance was not associated with variation in attentional control for individuals higher in trait anxiety. However, for individuals lower in trait anxiety, vigilance was negatively associated with attention control. The relationship between vigilance and attentional control was also moderated by SCL reactivity such that the association was only significant at lower SCL reactivity levels. Taken together, results suggest that individuals higher in trait anxiety demonstrate greater attentional control in the service of visual detection, but greater attentional control may come at the cost of increased sympathetic arousal.

Violence regulation and dysregulation system

Very early in childhood, relational trauma can lead to affect dysregulation in two directions: while intense fear determines the dysregulation of the brain system responsible for flight, uncontrolled aggression means the dysregulation of the brain centre responsible for fight. Both systems send the message of dysregulation in the autonomic nervous system. In both cases, there is a dysregulation of sympathetic arousal that exceeds the individual’s ability to cope with stress in a functional and effective manner. In other words, the flight response is triggered by immense fear, and the fight response is caused by intense anger and rage, which is functional in a normal response to trauma, while in the case of a dysregulated psycho-organic system it indicates a disorder that can have long-term consequences. These disorders can occur at a very early stage, in children who are at the time exposed to severe stress situations; this can lead to changes in the child’s neurobiological system, which may later become a source of psychopathology.