TMD LONGITUDINAL STUDIES: CLINICAL/CHRONIC PAIN SYNDROME

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This application requests continuation of the Program Project TMD Longitudinal Studies: Clinical/Chronic Pain Syndromes. {{The overall goal is to conduct multi-disciplinary research aimed at understanding the onset course, and appropriate care of chronic, recurrent pain conditions, with particular emphasis on temporomandibular disorders (TMD).}} The project will continue to focus on TMD as a clinical entity, the adaptation of persons with pain to their pain problem and the interaction of pain patients with the health care delivery system. An inn integral part of the research strategy will continue to be comparison with TMD with other common chronic pain conditions, {{in order to understand the degree to which findings are related to specific clinical entries or are associated with chronic pain more generally.}} Project 1 will assess the prevalence and incidence of TMD pain, headache, back pain and abdominal pain in adolescents, and identify risk factors for onset of each of these pain complaints. The prevalence of headache and TMD pain is much higher in adult women than in men; the studies are designed to test the hypothesis that these prevalence differences begin in adolescence and are associated with the hormonal changes of puberty. Project 2 aims to increase scientific understanding of the mechanisms by which beliefs and coping strategies affect adjustment of patients with chronic, recurrent pain. The project will evaluate, through a randomized clinical trial, whether a brief intervention designed to change beliefs and coping strategies enhances outcomes of patients receiving TMD treatment. Project 3 seeks a more effective and cost-effective integrated of medical care and self-care for chronic, recurrent pain in primary care settings. The aims are identify improved methods for analysis of automated health care and medicine use data for TMD, back pain and headache patients and identify modifiable determinants lf long-term health care use; evaluate the impact of self-care groups on long term health care and medication use. Project 4 is a randomized clinical trial to evaluate whether supplementing usual TMD treatment with low cost stepped care interventions that education patients in self care improves patients' pain reduces treatment seeking and improves functional status over time A Scientific Core will provide scientific direction, project coordination, data management/statistical support and shared scientific expertise. An Administrative ore will insure effective administration on the Program Project.