Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism

颞下颌关节/口面疼痛障碍（TMD）是一组疼痛性疾病， 决定因素已经开发了一些TMD的心理社会治疗方法，但总体而言， 疗效有限，治疗机制不明。该提案有两个 主要目标：1）开发一种高度个性化的，适应性的TMD治疗方法， 比其他心理治疗更有效; 2）发现机制， 心理治疗对慢性疼痛有效。TMD相关疼痛至少3个月的患者 持续时间（N=160）将随机分配至标准保守治疗+认知治疗 行为应对技能治疗（STD+CBT），或进行个性化评估和认知- 行为治疗计划（IATP）的TMD疼痛患者。IATP的治疗将基于 非常详细的功能分析病人的疼痛经验，在上下文中，从经验 取样（ES）。ES程序将通过智能手机应用程序进行，每天记录4次， 并将用于收集患者的疼痛，瞬间认知，影响和应对信息 行为，在治疗开始前进行为期2周的监测。治疗师会用这个 信息，以开发疼痛和非疼痛发作的个体功能分析，并确定 哪些想法、感受和行动对患者管理疼痛有效，哪些无效。 这些信息将用于帮助在6个疗程的治疗计划中制定适应性应对策略， 提供针对特定患者需求的技能培训。治疗期间，ES将允许调整 治疗目标和程序，使治疗具有适应性，并能够随着变化而变化 情况和病人的需要。该实验性治疗（IATP）将被添加到标准治疗中。 TMD疼痛（STD）的保守夹板治疗。组合（STD+IATP）将为 与STD治疗补充6个疗程的常规认知行为疗法相比， 该计划不基于对疼痛和应对的体内评估。在STD+CBT条件下，ES数据将 收集，但不用于通知治疗，但将控制测量反应性。ES 在两种治疗之前、期间和之后（长达12个月）收集的数据将允许非常精确的 认知、情感和应对技能的测量，因为它们发生在患者的家庭环境中， 以及它们如何随时间变化。结果将包括疼痛，干扰和抑郁的措施 症状该研究将能够根据近- 疼痛发作的真实的时间，允许随着治疗的进展进行调整，并测量影响 长期应对变化的结果。研究结果将有助于阐明 治疗TMD，并可能对其他慢性疼痛状况的管理产生影响。

Temporomandibular/orofacial pain disorders (TMD) are a group of painful conditions with multiple determinants. A number of psychosocial treatments for TMD have been developed, but overall effectiveness has been limited, and the mechanisms of treatment are unknown. This proposal has two main goals: 1) to develop a highly individualized, adaptive treatment for TMD that has potential to be more effective than other psychosocial treatments; and 2) to discover the mechanisms by which psychosocial treatments work in chronic pain. Patients with TMD-related pain of at least 3 months duration (N=160) will be randomly assigned to either a Standard Conservative Treatment +Cognitive Behavioral coping skills treatment (STD+CBT), or to an Individualized Assessment and cognitive- behavioral Treatment Program (IATP) for patients with TMD pain. Treatment in IATP will be based on a very detailed functional analysis of the patient's pain experience, in context, as derived from Experience Sampling (ES). The ES procedure will be conducted via smartphone app at a rate of 4 records per day, and will be used to gather information on patients' pain, momentary cognitions, affects, and coping behaviors, for a 2-week monitoring period prior to the beginning of treatment. Therapists will use this information to develop an individual functional analysis of pain and non-pain episodes, and determine what thoughts, feelings and actions are effective for that patient at managing pain and which are not. The information will be used to help develop adaptive coping tactics in a 6-session treatment program, offering skills training tailored to specific patient needs. During-treatment ES will allow adjustment of the treatment goals and procedures, making the treatment adaptive and able to change with changing circumstances and patient needs. This experimental treatment (IATP) will be added to a standard conservative splint-based treatment for TMD pain (STD). The combination (STD+IATP) will be compared to a STD treatment supplemented with a 6 session conventional cognitive-behavioral program not based on in-vivo assessment of pain and coping. In the STD+CBT condition ES data will be collected but will not be used to inform treatment, but will control for measurement reactivity. ES data collected prior to, during, and following both treatments (out to 12 months) will allow very precise measurement of cognitions, affects, and coping skills, as they occur in patients' home environments, and how they change over time. Outcomes will include measures of pain, interference, and depressive symptoms. The study will be able to tailor treatment based on patient experiences measured in near- real time at pain episodes, allow for adaptation of treatment as it progresses, and measure the impact on outcomes of coping changes over the long-term. The results will shed light on active mechanisms of treatment for TMD and may have implications for the management of other chronic pain conditions.