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

颞下颌骨/口面部疼痛障碍(TMD)是一组具有多种疼痛症状的疾病。 决定因素。已经开发了一些针对TMD的心理社会治疗方法，但总体来说 疗效有限，治疗机制尚不清楚。这项提案有两个 主要目标：1)开发一种高度个性化、适应性强的治疗TMD的方法，有可能 比其他心理社会治疗更有效；以及2)发现 心理社会治疗对慢性疼痛有效。与TMD相关的疼痛至少3个月的患者 持续时间(N=160)将随机分配给标准保守治疗认知 行为应对技能治疗(STD CBT)，或个性化评估和认知- TMD疼痛患者的行为治疗计划(IATP)。IATP的治疗将基于 根据体验对患者的疼痛体验进行非常详细的功能分析 取样。ES程序将通过智能手机应用程序以每天4条记录的速度进行， 并将用于收集有关患者疼痛、瞬间认知、情感和应对的信息 行为，在治疗开始前进行为期2周的监测。治疗师会用这个 对疼痛和非疼痛发作进行个人功能分析的信息，并确定 哪些想法、感觉和行动对患者有效，哪些无效。 这些信息将被用来帮助制定6个疗程的治疗计划中的适应性应对策略， 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，使治疗适应并能够随变化而改变 情况和病人的需要。这种实验性治疗(IATP)将被添加到标准 保守夹板治疗TMD疼痛(STD)。组合(STD IATP)将为 与STD治疗辅以6个疗程的常规认知行为相比 该计划不是基于对疼痛和应对的体内评估。在标准CBT条件下，ES数据将 将被收集，但不会用于通知治疗，但将控制测量的反应性。Es 在两种治疗之前、期间和之后(长达12个月)收集的数据将使非常准确 测量认知、情感和应对技能，当它们发生在患者的家庭环境中时， 以及它们如何随着时间的推移而变化。结果将包括疼痛、干扰和抑郁的测量。 症状。这项研究将能够根据患者的体验在近几年内进行量身定制的治疗 实时观察疼痛发作，允许在治疗进展过程中适应治疗，并测量影响 关于长期应对变化的结果。这一结果将有助于揭示其作用机制。 对于TMD的治疗，可能会对其他慢性疼痛的治疗产生影响。

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.