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.

中文翻译：

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慢性疼痛的流行病学研究：动态生态学视角

慢性疼痛的生物行为模型整合了流行病学的三个视角——人口、发展和生态——为流行病学疼痛研究提供了理论基础和模式。该模型表明，生理、心理和社会因素在疼痛和疼痛功能障碍发展的不同阶段以不同的方式相互作用，导致同一个人在不同时间的疼痛体验和行为存在很大差异。该模型的含义之一是，随着慢性疼痛的发展，疼痛感知、评估和行为的增强以及疼痛机制的变化可能部分解释与有害刺激和组织损伤程度不成比例的反应。本综述重点关注颞下颌关节紊乱 (TMD) 疼痛的流行病学和相关临床研究，以考虑流行病学对慢性疼痛研究的潜在贡献。本文回顾的研究结果表明，没有任何一个单独的因素——病理生理学、心理或社会因素——能够充分解释慢性疼痛状态。疼痛表达随时间的变化以及疼痛和疼痛功能障碍发展中生物、心理和社会因素的相互作用需要动态和多层次的生态学概念。确定了未来慢性疼痛和相关功能障碍流行病学研究的关键问题。