Association between temporomandibular disorders and somatization: a narrative review

Temporomandibular disorders (TMD) are common orofacial pain conditions with multifactorial etiologies. Somatization refers to the manifestation of psychological distress as physical symptoms in the absence of clear medical causes. A growing body of clinical research has recently shown a strong association between TMD and somatization. A substantial proportion of TMD patients exhibit moderate to high levels of somatic symptoms, leading to greater pain intensity, longer disease duration, and heightened psychological distress. The TMD-somatization relationship has been underpinned by complex pathophysiological interactions and the underlying mechanisms involved, including central sensitization (CS), potential biomarkers, nociplastic pain, neurobiological changes, and so on. Clinically, recognizing somatization in TMD patients is essential, as it can adversely affect treatment outcomes and necessitate a biopsychosocial management approach. In this narrative review, we summarize the clinical evidence of the TMD-somatization association, discuss the underlying mechanisms, explore management implications, and identify directions for future research.

Temporomandibular disorders; Somatization; Orofacial pain; Biopsychosocial

[1] Ferrillo M, Giudice A, Marotta N, Fortunato F, Di Venere D, Ammendolia A, et al. Pain management and rehabilitation for central sensitization in temporomandibular disorders: a comprehensive review. International Journal of Molecular Sciences. 2022; 23: 12164.

[2] Christidis N, Al-Moraissi EA, Barjandi G, Svedenlöf J, Jasim H, Christidis M, et al. Pharmacological treatments of temporomandibular disorders: a systematic review including a network meta-analysis. Drugs. 2024; 84: 59–81.

[3] Xie C, Lin M, Yang H, Ren A. Prevalence of temporomandibular disorders and its clinical signs in Chinese students, 1979–2017: a systematic review and meta-analysis. Oral Diseases. 2019; 25: 1697–1706.

[4] Zieliński G, Pająk-Zielińska B, Ginszt M. A meta-analysis of the global prevalence of temporomandibular disorders. Journal of Clinical Medicine. 2024; 13: 1365.

[5] Valesan LF, Da-Cas CD, Réus JC, Denardin ACS, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clinical Oral Investigations. 2021; 25: 441–453.

[6] List T, Jensen RH. Temporomandibular disorders: old ideas and new concepts. Cephalalgia. 2017; 37: 692–704.

[7] Harper DE, Schrepf A, Clauw DJ. Pain mechanisms and centralized pain in temporomandibular disorders. Journal of Dental Research. 2016; 95: 1102–1108.

[8] Gauer RL, Semidey MJ. Diagnosis and treatment of temporomandibular disorders. American Family Physician. 2015; 91: 378–386.

[9] Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. Journal of Dental Research. 2016; 95: 1093–1101.

[10] Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. The Journal of Headache and Pain. 2015; 16: 106.

[11] Golanska P, Saczuk K, Domarecka M, Kuć J, Lukomska-Szymanska M. Temporomandibular myofascial pain syndrome-aetiology and biopsychosocial modulation. A narrative review. International Journal of Environmental Research and Public Health. 2021; 18: 7807.

[12] Wang Y, Zhao Y, Xie Q. Visual psychosocial profiling of Chinese temporomandibular disorder pain patients and correlations with somatosensory function. Journal of Oral Rehabilitation. 2024; 51: 1401–1412.

[13] List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses. Journal of Oral Rehabilitation. 2010; 37: 430–451.

[14] Mayou R. Somatization. Psychotherapy and Psychosomatics. 1993; 59: 69–83.

[15] van Driel TJW, Hilderink PH, Hanssen DJC, de Boer P, Rosmalen JGM, Oude Voshaar RC. Assessment of somatization and medically unexplained symptoms in later life. Assessment. 2018; 25: 374–393.

[16] Noyes R Jr, Holt CS, Kathol RG. Somatization. Diagnosis and management. Archives of Family Medicine. 1995; 4: 790–795.

[17] Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychotherapy and Psychosomatics. 2000; 69: 205–215.

[18] Lajnert V, Francisković T, Grzic R, Kovacević Pavicić D, Bakarbić D, Buković D, et al. Depression, somatization and anxiety in female patients with temporomandibular disorders (TMD). Collegium Antropologicum. 2010; 34: 1415–1419.

[19] Yap AU, Dewi NL, Marpaung C. Psychological characteristics of young adults with temporomandibular disorders, somatization and combined conditions: a multidimensional evaluation. Journal of Oral Rehabilitation. 2023; 50: 1382–1392.

[20] Yap AU, Kim S, Jo JH, Lee BM, Park JW. Exploring the relationship between somatisation, facial pain and psychological distress in east asian temporomandibular disorder patients. Journal of Oral Rehabilitation. 2024; 51: 2566–2576.

[21] Ujin Yap A, Kurniawan F, Pragustine Y, Marpaung C. Temporomandibular disorder and somatic symptoms: relations to ‘fear of missing out’ and other negative emotional states. Acta Odontologica Scandinavica. 2024; 83: 340–347.

[22] Ye C, Pu D, Zhang J, Jia M, Zhang Y, Du S, et al. Unlocking the link between temporomandibular disorders and suicide ideation in pre-orthodontic patients: a moderated mediation model of depression and anxiety. Journal of Affective Disorders. 2024; 349: 486–493.

[23] Sun W, Fang S, Wang Y, Zheng Y, Zhou X, Yi Y, et al. Prevalence and associated factors of health anxiety in patients with temporomandibular disorders. Oral Diseases. 2025; 31: 181–192.

[24] Manfredini D, Borella L, Favero L, Ferronato G, Guarda-Nardini L. Chronic pain severity and depression/somatization levels in TMD patients. The International Journal of Prosthodontics. 2010; 23: 529–534.

[25] Sherman JJ, LeResche L, Huggins KH, Mancl LA, Sage JC, Dworkin SF. The relationship of somatization and depression to experimental pain response in women with temporomandibular disorders. Psychosomatic Medicine. 2004; 66: 852–860.

[26] Su N, Lobbezoo F, van Wijk A, van der Heijden GJ, Visscher CM. Associations of pain intensity and pain-related disability with psychological and socio-demographic factors in patients with temporomandibular disorders: a cross-sectional study at a specialised dental clinic. Journal of Oral Rehabilitation. 2017; 44: 187–196.

[27] Canales GT, Guarda-Nardini L, Rizzatti-Barbosa CM, Conti PCR, Manfredini D. Distribution of depression, somatization and pain-related impairment in patients with chronic temporomandibular disorders. Journal of Applied Oral Science. 2019; 27: e20180210.

[28] Schmitter M, Kares-Vrincianu A, Kares H, Malsch C, Schindler HJ. Chronic stress and temporalis muscle activity in TMD patients and controls during sleep: a pilot study in females. Clinical Oral Investigations. 2019; 23: 667–672.

[29] Restrepo C, Ortiz AM, Henao AC, Manrique R. Association between psychological factors and temporomandibular disorders in adolescents of rural and urban zones. BMC Oral Health. 2021; 21: 140.

[30] Yap AU, Marpaung C. Personality, psychosocial and oral behavioural risk factors for temporomandibular disorder symptoms in asian young adults. Journal of Oral Rehabilitation. 2023; 50: 931–939.

[31] Yang Y, Xu LL, Liu SS, Lu SJ, Liu LK, Zeng H, et al. Analysis of risk factors and interactions for pain in temporomandibular disorder: a cross-sectional study. Journal of Oral Rehabilitation. 2024; 51: 1113–1122.

[32] Lee SH, Jo JH, Park JW. Temporomandibular disorders patients with migraine symptoms have increased disease burden due to psychological conditions. Journal of Oral & Facial Pain and Headache. 2025; 39: 70–80.

[33] Viñals Narváez AC, Sánchez-Sánchez T, García-González M, Ardizone García I, Cid-Verdejo R, Sánchez Romero EA, et al. Psychological and behavioral factors involved in temporomandibular myalgia and migraine: common but differentiated profiles. International Journal of Environmental Research and Public Health. 2023; 20: 1545.

[34] Manfredini D, Favero L, Del Giudice A, Masiero S, Stellini E, Guarda-Nardini L. Axis II psychosocial findings predict effectiveness of TMJ hyaluronic acid injections. International Journal of Oral And Maxillofacial Surgery. 2013; 42: 364–368.

[35] Litt MD, Shafer DM, Kreutzer DL. Brief cognitive-behavioral treatment for TMD pain: long-term outcomes and moderators of treatment. Pain. 2010; 151: 110–116.

[36] Celić R, Braut V, Petricević N. Influence of depression and somatization on acute and chronic orofacial pain in patients with single or multiple TMD diagnoses. Collegium Antropologicum. 2011; 35: 709–713.

[37] Jo JH, Son C, Chung JW, Park JW. Presence of widespread pain predicts comorbidities and treatment response in temporomandibular disorders patients. Oral Diseases. 2022; 28: 1682–1696.

[38] Warzocha J, Gadomska-Krasny J, Mrowiec J. Etiologic factors of temporomandibular disorders: a systematic review of literature containing diagnostic criteria for temporomandibular disorders (DC/TMD) and research diagnostic criteria for temporomandibular disorders (RDC/TMD) from 2018 to 2022. Healthcare. 2024; 12: 575.

[39] Yap AU, Sultana R, Natu VP. Stress and emotional distress: their associations with somatic and temporomandibular disorder-related symptoms. Psychology, Health & Medicine. 2022; 27: 876–887.

[40] Cho YK, Jung YL, Im A, Hong SJ, Kim K. Social media-based pain neuroscience education for temporomandibular joint disorder: a randomized controlled trial. Pain Management Nursing. 2025; 26: e261–e269.

[41] Brighenti N, Battaglino A, Sinatti P, Abuín-Porras V, Sánchez Romero EA, Pedersini P, et al. Effects of an interdisciplinary approach in the management of temporomandibular disorders: a scoping review. International Journal of Environmental Research and Public Health. 2023; 20: 2777.

[42] Militi A, Bonanno M, Calabrò RS. It is time for a multidisciplinary rehabilitation approach: a scoping review on stomatognathic diseases in neurological disorders. Journal of Clinical Medicine. 2023; 12: 3528.

[43] Melchior MO, Magri LV, Victoria Díaz-Serrano K, Leite-Panissi CRA, Gherardi-Donato ECS. How do the mindfulness and sensory-behavioural-emotional aspects influence the painful experience related to temporomandibular disorder? Journal of Oral Rehabilitation. 2024; 51: 1175–1183.

[44] Fjorback LO, Arendt M, Ornbøl E, Walach H, Rehfeld E, Schröder A, et al. Mindfulness therapy for somatization disorder and functional somatic syndromes: randomized trial with one-year follow-up. Journal of Psychosomatic Research. 2013; 74: 31–40.

[45] Salbego RS, Conti PCR, Soares FFC, Ferreira DMAO, Herreira-Ferreira M, de Lima-Netto BA, et al. Central sensitization inventory is associated with psychological functioning but not with psychophysical assessment of pain amplification. European Journal of Pain. 2025; 29: e4713.

[46] Mercante FG, Fernandes G, Braido GVDV, Proença JDS, Andersen ML, Hachul H, et al. Insomnia is associated with symptoms of central sensitization in patients with painful temporomandibular disorders. Journal of the American Dental Association. 2023; 154: 1024–1031.

[47] Vale Braido GVD, Svensson P, Dos Santos Proença J, Mercante FG, Fernandes G, de Godoi Gonçalves DA. Are central sensitization symptoms and psychosocial alterations interfering in the association between painful TMD, migraine, and headache attributed to TMD? Clinical Oral Investigations. 2023; 27: 681–690.

[48] Dickie AC, McCormick B, Lukito V, Wilson KL, Torsney C. Inflammatory pain reduces C fiber activity-dependent slowing in a sex-dependent manner, amplifying nociceptive input to the spinal cord. Journal of Neuroscience. 2017; 37: 6488–6502.

[49] Maixner W, Fillingim R, Sigurdsson A, Kincaid S, Silva S. Sensitivity of patients with painful temporomandibular disorders to experimentally evoked pain: evidence for altered temporal summation of pain. Pain. 1998; 76: 71–81.

[50] Pagliusi M Jr, Bonet IJM, Lemes JBP, Oliveira ALL, Carvalho NS, Tambeli CH, et al. Social defeat stress-induced hyperalgesia is mediated by nav 1.8+ nociceptive fibers. Neuroscience Letters. 2020; 729: 135006.

[51] Becker C, Zeau B, Rivat C, Blugeot A, Hamon M, Benoliel JJ. Repeated social defeat-induced depression-like behavioral and biological alterations in rats: involvement of cholecystokinin. Molecular Psychiatry. 2008; 13: 1079–1092.

[52] Calixtre LB, van der Meer HA, Visscher CM, de Oliveira AB, de Godoi Gonçalves DA. The association between the central sensitisation inventory and temporomandibular disorders is confounded by migraine, depression, widespread pain and parafunction. A cross-sectional telehealth study. Journal of Oral Rehabilitation. 2024; 51: 2577–2587.

[53] Seweryn P, Waliszewska-Prosol M, Straburzynski M, Smardz J, Orzeszek S, Bombala W, et al. Prevalence of central sensitization and somatization in adults with temporomandibular disorders—a prospective observational study. Journal of Oral & Facial Pain and Headache. 2024; 38: 33–44.

[54] Maes M. Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms. Current Opinion in Psychiatry. 2009; 22: 75–83.

[55] Braz MA, Freitas Portella F, Seehaber KA, Bavaresco CS, Rivaldo EG. Association between oxidative stress and temporomandibular joint dysfunction: a narrative review. Journal of Oral Rehabilitation. 2020; 47: 536–546.

[56] Shrivastava M, Battaglino R, Ye L. A comprehensive review on biomarkers associated with painful temporomandibular disorders. International Journal of Oral Science. 2021; 13: 23.

[57] Kim Y, Son C, Park YK, Jo JH, Park JW. Sleep duration and inflammatory mediator levels associated with long-term prognosis in temporomandibular disorders. Journal of Oral Rehabilitation. 2023; 50: 830–839.

[58] Kuć J, Szarejko KD, Maciejczyk M, Dymicka-Piekarska V, Żendzian-Piotrowska M, Zalewska A. Oxidative imbalance as a co-player in jaw functional limitations and biopsychosocial profile in patients with temporomandibular disorder—myofascial pain with referral. Frontiers in Neurology. 2025; 15: 1509845.

[59] Euteneuer F, Schwarz MJ, Hennings A, Riemer S, Stapf T, Selberdinger V, et al. Psychobiological aspects of somatization syndromes: contributions of inflammatory cytokines and neopterin. Psychiatry Research. 2012; 195: 60–65.

[60] Sahm AHJ, Witthöft M, Bailer J, Mier D. Putting the vicious cycle to the test: evidence for the cognitive behavioral model of persistent somatic symptoms from an online study. Psychosomatic Medicine. 2024; 86: 569–575.

[61] Kim HK, Kim ME. Deepening the understanding of somatization in TMD pain: a topical review. Journal of Oral Medicine and Pain. 2022; 47: 78–86.

[62] Bouguezzi A, Fantar A, Hentati H, Selmi J. The interplay between psychological stress and temporomandibular joint disorders: a comprehensive review. 2025; 7: 19.

[63] Lin J, Cao DY. Associations between temporomandibular disorders and brain imaging-derived phenotypes. International Dental Journal. 2024; 74: 784–793.

[64] Lim M, Nascimento TD, Kim DJ, Ellingrod VL, DaSilva AF. Aberrant brain signal variability and COMT genotype in chronic TMD patients. Journal of Dental Research. 2021; 100: 714–722.

[65] Besteher B, Gaser C, Langbein K, Dietzek M, Sauer H, Nenadić I. Effects of subclinical depression, anxiety and somatization on brain structure in healthy subjects. Journal of Affective Disorders. 2017; 215: 111–117.

[66] Zhao R, Ye Z, Lv X, Li Z, Xiong X. Imaging brain networks: insights into mechanisms of temporomandibular disorders. Journal of Dental Research. 2025; 104: 380–388.

[67] Yin YY, Li F, He SS, Chen S. Abnormal static and dynamic brain function in patients with temporomandibular disorders: a resting-state functional magnetic resonance imaging study. West China Journal of Stomatology. 2021; 39: 682–689. (In Chinese)

[68] Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. The Lancet. 2021; 397: 2098–2110.

[69] Kosek E, Clauw D, Nijs J, Baron R, Gilron I, Harris RE, et al. Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain. 2021; 162: 2629–2634.

[70] Lam J, Mårtensson J, Westergren H, Svensson P, Sundgren PC, Alstergren P. Structural MRI findings in the brain related to pain distribution in chronic overlapping pain conditions: an explorative case-control study in females with fibromyalgia, temporomandibular disorder-related chronic pain and pain-free controls. Journal of Oral Rehabilitation. 2024; 51: 2415–2426.

[71] Suenaga S, Nagayama K, Nagasawa T, Indo H, Majima HJ. The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders. Japanese Dental Science Review. 2016; 52: 93–106.

[72] Lipowski ZJ. Somatization: the experience and communication of psychological distress as somatic symptoms. Psychotherapy and Psychosomatics. 1987; 47: 160–167.

[73] Yap AU, Kim S, Lee BM, Jo JH, Park JW. Correlates of jaw functional limitation, somatization and psychological distress among different temporomandibular disorder diagnostic subtypes. Journal of Oral Rehabilitation. 2024; 51: 287–295.

[74] Yap AU, Natu VP. Inter-relationships between pain-related temporomandibular disorders, somatic and psychological symptoms in asian youths. Journal of Oral Rehabilitation. 2020; 47: 1077–1083.

[75] Jung W, Lee KE, Suh BJ. Influence of psychological factors on the prognosis of temporomandibular disorders pain. Journal of Dental Sciences. 2021; 16: 349–355.

[76] Reiche EMV, Nunes SOV, Morimoto HK. Stress, depression, the immune system, and cancer. The Lancet Oncology. 2004; 5: 617–625.

[77] Knezevic E, Nenic K, Milanovic V, Knezevic NN. The role of cortisol in chronic stress, neurodegenerative diseases, and psychological disorders. Cells. 2023; 12: 2726.

[78] Yao L, Sadeghirad B, Li M, Li J, Wang Q, Crandon HN, et al. Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials. The BMJ. 2023; 383: e076226.

[79] Yap AU, Marpaung C. Psychologic factors in temporomandibular disorders and somatization: a multidimensional analysis of personality, coping, and distress among young adults. International Journal of Prosthodontics. 2024; 37: 605–614.

[80] Yap AU, Chua EK, Dworkin SF, Tan HH, Tan KB. Multiple pains and psychosocial functioning/psychologic distress in TMD patients. The International Journal of Prosthodontics. 2002; 15: 461–466.

[81] Brakus RB, Brakus I, Carek A, Galić T, Alajbeg IZ. Evaluating amitriptyline’s role in chronic TMD management: a placebo-controlled trial. BMC Oral Health. 2025; 25: 334.

[82] Dei T, Galloway K, Fagundes NCF, Kung JY, Beahm NP, Friesen R. Beyond depression: the role of antidepressants in managing chronic temporomandibular disorders. A systematic review. Journal of Oral Rehabilitation. 2025; 52: 923–936.

[83] Ferreira DMAO, Soares FFC, Raimundini AA, Bonjardim LR, Costa YM, Conti PCR. Prediction of duloxetine efficacy in addition to self-management in painful temporomandibular disorders: a randomised, placebo-controlled clinical trial. Journal of Oral Rehabilitation. 2024; 51: 476–486.

[84] Gosmann NP, Costa MA, Jaeger MB, Motta LS, Frozi J, Spanemberg L, et al. Selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for anxiety, obsessive-compulsive, and stress disorders: a 3-level network meta-analysis. PLOS Medicine. 2021; 18: e1003664.

[85] Shafiee A, Jafarabady K, Seighali N, Mohammadi I, Rajai Firouz Abadi S, Abhari FS, et al. Effect of saffron versus selective serotonin reuptake inhibitors (SSRIs) in treatment of depression and anxiety: a meta-analysis of randomized controlled trials. Nutrition Reviews. 2025; 83: e751–e761.

[86] Wichniak A, Wierzbicka A, Walęcka M, Jernajczyk W. Effects of antidepressants on sleep. Current Psychiatry Reports. 2017; 19: 63.

[87] Plaza-Manzano G, Delgado-de-la-Serna P, Díaz-Arribas MJ, Rodrigues-de-Souza DP, Fernández-de-Las-Peñas C, Alburquerque-Sendín F. Influence of clinical, physical, psychological, and psychophysical variables on treatment outcomes in somatic tinnitus associated with temporomandibular pain: evidence from a randomized clinical trial. Pain Practice. 2021; 21: 8–17.

[88] González-Sánchez B, García Monterey P, Ramírez-Durán MDV, Garrido-Ardila EM, Rodríguez-Mansilla J, Jiménez-Palomares M. Temporomandibular joint dysfunctions: a systematic review of treatment approaches. Journal of Clinical Medicine. 2023; 12: 4156.

[89] Rodríguez de Sotillo D, Velly AM, Hadley M, Fricton JR. Evidence of oxidative stress in temporomandibular disorders: a pilot study. Journal of Oral Rehabilitation. 2011; 38: 722–728.

[90] Li DJ, Li YH, Yuan HB, Qu LF, Wang P. The novel exercise-induced hormone irisin protects against neuronal injury via activation of the Akt and ERK1/2 signaling pathways and contributes to the neuroprotection of physical exercise in cerebral ischemia. Metabolism. 2017; 68: 31–42.

[91] Leal LG, Lopes MA, Batista ML III. Physical exercise-induced myokines and muscle-adipose tissue crosstalk: a review of current knowledge and the implications for health and metabolic diseases. Frontiers in Physiology. 2018; 9: 1307.

[92] Moleirinho-Alves PMM, Cebola PMTC, Dos Santos PDG, Correia JP, Godinho C, Oliveira RANDS, et al. Effects of therapeutic and aerobic exercise programs on pain, neuromuscular activation, and bite force in patients with temporomandibular disorders. Journal of Personalized Medicine. 2021; 11: 1170.

[93] Anker EA, Sande T, Arefjord K, Hystad SW, Rosén A. The association between pain-related factors and psychological distress in patients with temporomandibular disorder. Psychology, Health & Medicine. 2023; 28: 1049–1056.

[94] Mirchandaney R, Barete R, Asarnow LD. Moderators of cognitive behavioral treatment for insomnia on depression and anxiety outcomes. Current Psychiatry Reports. 2022; 24: 121–128.

[95] Busse JW, Casassus R, Carrasco-Labra A, Durham J, Mock D, Zakrzewska JM, et al. Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline. The BMJ. 2023; 383: e076227.

[96] Shimada A, Ishigaki S, Matsuka Y, Komiyama O, Torisu T, Oono Y, et al. Effects of exercise therapy on painful temporomandibular disorders. Journal of Oral Rehabilitation. 2019; 46: 475–481.

[97] Iwata K, Sessle BJ. The evolution of neuroscience as a research field relevant to dentistry. Journal of Dental Research. 2019; 98: 1407–1417.

[98] Mattson MP, Moehl K, Ghena N, Schmaedick M, Cheng A. Intermittent metabolic switching, neuroplasticity and brain health. Nature Reviews Neuroscience. 2018; 19: 63–80.

[99] von Piekartz H, Bleiss S, Herzer S, Hall T, Ballenberger N. Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study. Journal of Oral Rehabilitation. 2024; 51: 1692–1700.

[100] Aggarwal VR, Fu Y, Main CJ, Wu J. The effectiveness of self-management interventions in adults with chronic orofacial pain: a systematic review, meta-analysis and meta-regression. European Journal of Pain. 2019; 23: 849–865.

[101] Story WP, Durham J, Al-Baghdadi M, Steele J, Araujo-Soares V. Self-management in temporomandibular disorders: a systematic review of behavioural components. Journal of Oral Rehabilitation. 2016; 43: 759–770.

[102] Durham J, Al-Baghdadi M, Baad-Hansen L, Breckons M, Goulet JP, Lobbezoo F, et al. Self-management programmes in temporomandibular disorders: results from an international Delphi process. Journal of Oral Rehabilitation. 2016; 43: 929–936.

[103] Ghurye S, McMillan R. Pain-related temporomandibular disorder—current perspectives and evidence-based management. Dental Update. 2015; 42: 533–536, 539–542, 545–536.

[104] Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful temporomandibular disorder: decade of discovery from OPPERA studies. Journal of Dental Research. 2016; 95: 1084–1092.

[105] Barjandi G, Kosek E, Hedenberg-Magnusson B, Velly AM, Ernberg M. Comorbid conditions in temporomandibular disorders myalgia and myofascial pain compared to fibromyalgia. Journal of Clinical Medicine. 2021; 10: 3138.

[106] Iodice G, Michelotti A, D’Antò V, Martina S, Valletta R, Rongo R. Prevalence of psychosocial findings and their correlation with TMD symptoms in an adult population sample. Progress in Orthodontics. 2024; 25: 39.

[107] Yin Y, He S, Xu J, You W, Li Q, Long J, et al. The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies. The Journal of Headache and Pain. 2020; 21: 78.

[108] Maes M, Rief W. Diagnostic classifications in depression and somatization should include biomarkers, such as disorders in the tryptophan catabolite (TRYCAT) pathway. Psychiatry Research. 2012; 196: 243–249.

[109] Anderson G, Berk M, Maes M. Biological phenotypes underpin the physio-somatic symptoms of somatization, depression, and chronic fatigue syndrome. Acta Psychiatrica Scandinavica. 2014; 129: 83–97. ADDIN EN.REFLIST