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Papers of the Week


Papers: 20 Apr 2019 - 26 Apr 2019


2019 Nov


J Pain


20


11

AAPT Diagnostic Criteria for Chronic Painful Temporomandibular Disorders.

Authors

Ohrbach R, Dworkin SF
J Pain. 2019 Nov; 20(11):1276-1292.
PMID: 31004786.

Abstract

The classification of temporomandibular disorders (TMD) has progressed substantially over the past 25 years due to the strategic implementation of an initial classification system based on core taxonomic principles. In this article we describe the development of the DC/TMD and its translation into the multidimensional ACTTION-American Pain Society Pain Taxonomy (AAPT) for chronic pain disorders. The initial scientific classification system (RDC/TMD) relied upon a boot-strapping process that did not attempt to solve all known clinical problems but, rather, focused on problems that could be solved at that time. The core design principles included using epidemiological data, operationalized concepts, reliable methods, and incorporation of the biopsychosocial model into a dual-axis system. This system led to sufficient data collection internationally that the system itself could be revised, first by critical evaluation of all aspects, second by review from invited experts, and third by the construction of a revised taxonomy (DC/TMD) that maintained the core design principles of the RDC/TMD. The resultant disorders with pain as a dominant feature exhibit substantial sensitivity and specificity, and they have been translated into the AAPT framework. The AAPT TMD criteria are part of an evidence-based classification system providing a systematic structure that includes five dimensions: diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms. Future research will attempt to extend this AAPT domain from solely TMDs to include other orofacial pain conditions. PERSPECTIVE: The painful TMDs have well-established sensitivity and specificity, as based on the DC/TMD; their translation to the AAPT framework for chronic pain conditions provides a structure for consistent clinical application within the broader health care settings and for future research on the TMDs.