Biopsychosocial Predictors of Pain Persistence and Pain Chronification in Temporomandibular Disorders: A Systematic Review.

Abstract

<b>Background/Objectives:</b> Temporomandibular disorders (TMD) are common causes of orofacial pain, but their clinical course varies, with some patients developing persistent symptoms. Evidence supports a biopsychosocial model of pain chronification, yet prognostic factors for pain persistence in TMD remain insufficiently synthesized. This systematic review aimed to identify biological, psychological, and social predictors associated with pain persistence and chronicity in painful TMD. <b>Methods:</b> This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420261286566). MEDLINE, Embase, and Web of Science were searched for studies published between January 2010 and December 2025. Eligible studies included adult patients with painful TMD and assessed baseline biopsychosocial predictors of pain persistence or chronicity at follow-up ≥ 3 months. Risk of bias was assessed using QUIPS and PROBAST. Due to heterogeneity across studies, findings were synthesized narratively. <b>Results:</b> Six prospective cohort studies were included, with follow-up durations ranging from 6 to 24 months. Psychological factors, particularly pain catastrophizing and depression, were associated with increased risk of pain persistence. Higher baseline pain intensity and widespread pain also showed prognostic value. Sleep-related and behavioral factors demonstrated inconsistent associations, and social predictors were rarely examined. The certainty of evidence ranged from moderate for catastrophizing and pain intensity to very low for sleep-related and occlusal factors. <b>Conclusions:</b> Pain persistence in TMD is influenced by multiple biopsychosocial factors. Psychological variables, especially catastrophizing and depression, appear to be the most consistent predictors, although this finding should be interpreted with caution, given the small number of included studies. These findings highlight the importance of comprehensive biopsychosocial assessment in patients with painful TMD and the need for further longitudinal research.