AN EVALUATION AND TREATMENT STUDY OF TMD

TMD 的评估和治疗研究

• 批准号: 6379753
• 负责人: ROBERT Joseph GATCHEL
• 金额: $ 26.52万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1994
• 资助国家: 美国
• 起止时间: 1994-06-01 至 2004-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6379753
• 关键词: behavioral /social science research tag; biofeedback; chronic disease /disorder; chronic pain; clinical research; cognitive behavior therapy; combination therapy; diagnosis quality /standard; human subject; human therapy evaluation; longitudinal human study; muscle disorder diagnosis; musculoskeletal disorder diagnosis; musculoskeletal disorder therapy; oral facial pain; temporomandibular joint syndrome

DESCRIPTION: (from the application) A major goal of a past funded grant project was to identify useful predictors of when acute temporomandibular disorder (TMD) incidents were likely to develop into chronic problems. With the great economic cost and traditionally poor outcomes among chronic TMD patients, it has become increasingly more important to effectively treat patients in the acute state in order to prevent these more chronic disability problems. Results of this past project clearly isolated risk factors that predict chronicity. As an extension of these important findings, we now have a statistical algorithm that can be used to identify acute TMD patients who are prime candidates for early intervention in order to prevent chronicity. The present proposed project will involve the assessment of a large cohort of acute TMD patients in order to screen out those patients who are at "high risk" for developing chronicity. These high-risk patients will then be randomly assigned to one of two groups (30 patients/group): an early intervention group or a non-intervention group. The intervention procedure will be modeled after that found to be most effective in our past R01 grant project - a combined biofeedback/cognitive behavioral treatment approach. One-year follow-up evaluations will subsequently be conducted in order to assess important outcomes such as pain, disability, relapse, and health-care utilization rates. It is hypothesized that early intervention at the acute stage will prevent the development of chronic disability. In addition, as a replication of the previous grant project results, the non-intervention group patients will be compared to a demographically matched cohort (n=60) of initially assessed acute TMD patients who do not display the "high risk" profile. It is hypothesized that the "high risk" non-intervention group patients will demonstrate higher rates of pain and disability at one year relative to the "low risk" profile patients. These results will have major implications for effective early intervention and result in significant health-care cost savings for this prevalent pain problem. Finally, an additional goal of this present proposed project will be the evaluation of a potentially heuristic theory of the interaction of pain and stress recently proposed by Mezack (1996). The present proposed project will begin evaluating the potential validity of this theory by assessing a key biological index (cortisol) that Melzack proposes to be intimately involved in the stress-pain interaction process. The better understanding of such a mechanism can potentially yield even more effective assessment and treatment approaches for chronic pain syndromes such as TMD.

描述：（来自申请）过去资助的资助项目的主要目标 目的是确定急性颞下颌关节紊乱病的有用预测因子 （TMD）事件很可能会发展成为长期问题。与伟大的 慢性 TMD 患者的经济成本和传统上的不良结果， 有效治疗患者变得越来越重要 急性状态，以防止这些更慢性的残疾问题。结果 过去的项目清楚地隔离了预测慢性病的风险因素。作为 这些重要发现的延伸，我们现在有了一个统计算法 可用于识别急性 TMD 患者，这些患者是主要候选者 早期干预以防止慢性化。目前拟建项目 将涉及对一大群急性 TMD 患者进行评估，以便 筛查出那些处于慢性病“高风险”的患者。 然后，这些高风险患者将被随机分配到两组中的一组 （30名患者/组）：早期干预组或非干预组。 干预程序将按照最有效的程序进行建模 在我们过去的 R01 资助项目中有效 - 生物反馈/认知相结合 行为治疗方法。随后将进行为期一年的跟踪评估 进行以评估重要结果，例如疼痛、残疾、 复发率和医疗保健利用率。据推测，早 急性期的干预可以防止慢性病的发展 残疾。此外，作为先前资助项目的复制 结果，非干预组患者将与非干预组患者进行比较 最初评估的急性 TMD 患者的人口统计学匹配队列 (n=60) 没有表现出“高风险”特征的人。据推测，“高 风险”非干预组患者将表现出更高的疼痛率和 与“低风险”患者相比，一年后残疾。这些 结果将对有效的早期干预和 对于这种普遍存在的疼痛问题，可以节省大量的医疗费用。 最后，本提议项目的另一个目标是 评估疼痛和疼痛相互作用的潜在启发式理论 Mezack (1996) 最近提出了应力。目前拟议的项目将 通过评估一个关键点来开始评估该理论的潜在有效性 梅尔扎克提出密切参与的生物指数（皮质醇） 压力-疼痛相互作用过程。更好地理解这样一个 机制可能会产生更有效的评估和治疗 治疗慢性疼痛综合征（如TMD）的方法。