The temporomandibular disorders (TMDs) comprise a constellation of symptoms affecting the joints and muscles involved in jaw movement. Patients complain of orofacial pain, limited jaw opening, and clicking or popping sounds. Although pain is generally the defining characteristic of TMD, patients often report marked degrees of stress and interference in daily life. This article reviews recent studies on epidemiology, sex differences, pediatric TMD, classification systems, comparisons to other chronic pain disorders of uncertain etiology, psychological assessment, depression, central modulation and hypervigilance, sleep disturbances, stress, and the management of TMD by conservative physical interventions and cognitive behavioral therapy. Both the assessment and the management of TMD requires a multidisciplinary perspective with strong emphasis on psychosocial variables.

Previous studies have generally indicated sizeable sex differences for both laboratory pain reactivity and clinical pain reports. Numerous biological and psychosocial models have been invoked to account for these findings, but the laboratory and clinical findings have generally been examined in isolation. This paper reviews data which show a relationship between past clinical pain experiences and current responses to experimentally induced pain. Individuals with a greater pain history tend to show lower pain tolerance. Since women often have high pain experience levels and lower pain tolerance, one might ask whether the two factors are related. We review several models, based upon concepts of neonatal differences in pain reactivity, hypervigilance following early pain experiences, and concepts of peripheral and central sensitization or plasticity which might help to bridge the gap between clinical and experimental findings.

Needle procedures are a painful and distressing experience for many children. There is a strong evidence base that demonstrates the efficacy of psychological interventions for reducing pain and distress during needle procedures. However, actual implementation of these strategies before, during, and after a needle procedure is affected by multiple factors that increase the complexity of delivery of these interventions in clinical settings. These challenges include application of evidencebased strategies to diverse populations that tend to be excluded from the research literature (e.g., children with developmental delays, children with needle anxiety or phobia), environmental barriers (e.g., providing pain management strategies for needle procedures in different settings), and practical or logistical issues (e.g., inadequate preparation time). We discuss these issues, provide practical suggestions for increasing access to evidence-based pain management strategies, and present three illustrative case examples. Pediatric psychologists may face challenges in implementing evidence-based strategies for needle pain and distress, but important opportunities for educating families and health professionals about the management of procedural pain from needles are available.

Children's declarative memories of medical procedures can influence their responses to subsequent events. No previous study has examined the accuracy of children's declarative memories after surgery. We tested the memory of 34 anesthesia-naïve five- to nine-year-old children undergoing ambulatory surgery for accuracy of contextual details, pain, and fear two weeks postoperatively. Parents were not present during induction, and we did not use sedative premedication. Children had a mean contextual recall accuracy of 64.5%. Most children (60.6%) remembered a prompt that was given one minute after receiving nitrous oxide. Children's memories of pain and fear were similar to their reported pain and fear on the day of surgery. Of 29 children, 6 (20.7%) exaggerated their memory of fear, and 8 of 22 children (36.4%) exaggerated their memory of pain. Although a small proportion of children had exaggerated memories, there was no evidence of consistent bias in their memory of fear or pain.

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