Pain in adolescents: biologic/psychosocial risk factors

我们提出一项为期五年的研究计划，旨在评估青少年颞下颌紊乱（TMD）疼痛、头痛、背痛和腹痛的患病率和发病率。以及确定每一种常见疼痛{{症状}}发病的危险因素。由于成年女性头痛和TMD疼痛的患病率远高于成年男性，因此这些研究旨在验证一种全球假设，即这种患病率差异始于青春期，并与青春期激素的变化有关。研究1的具体目的是：1)通过电话调查，评估年龄和性别分层的11- 17岁青少年（最终n= 2970） TMD疼痛、头痛、背痛和腹痛的患病率、严重程度和时间特征；2)识别这四个部位疼痛的潜在危险因素；3)对所有报告TMD疼痛的受访者，以及没有TMD疼痛的受访者样本（预计每个报告TMD疼痛的受访者n = 130人）和没有TMD疼痛的受访者样本（预计n = 130人）进行标准化检查和访谈，以便：a)比较病例和对照组中颞下颌关节疾病的临床症状和体征的比率，b)使用标准化的检查方法和诊断算法估计TMD特定临床亚型（肌筋膜疼痛、椎间盘移位、关节痛、关节炎/关节病）的患病率。检查将由经过培训的注册牙科保健师在受试者家中进行，并根据可靠性进行校准。研究2的具体目的是：1)对研究1中11岁的被调查者（n= 1902）进行为期3年的随访，采用简短的邮件调查和更广泛的18个月和3年的随访数据收集。监测TMD疼痛、头痛、背痛和腹痛的发生率。评估这些疼痛问题对活动的干扰、药物的使用和治疗疼痛的保健使用率的影响；2)确定发生{{TMD疼痛、头痛、背部和腹部疼痛}}的危险因素>所有疼痛的假设危险因素包括：女性性别、现有疼痛主诉和其他躯体症状的次数、前一年就诊次数和心理困扰；此外，我们假设性成熟是TMD疼痛和头痛发病的危险因素；3)估计3年随访期间各疼痛依从性的抵消率和复发率；4)使用研究1中描述的检查方法和诊断算法对TMD疼痛发生率进行检查，以估计特定亚型TMD的患病率。

We propose a five-year program of research aimed at assessing the prevalence and incidence of temporomandibular disorder (TMD) pain, headache, back pain, and abdominal pain in adolescents., and identifying risk factors for onset of each of these common pain {{symptoms}}. Because the prevalence of headache and TMD pain is much higher in adult women than in adult men, the studies are designed to test the global hypothesis that this prevalence differences begin in adolescence and are associated with the hormonal change of puberty. The specific aims of study 1 are: 1) In a telephone survey, assess the prevalence, severity and temporal characteristics of TMD pain, headache, backpain and abdominal pain in an age- and sex-stratified random sample of adolescents, ages 11- 17 (final n= 2970) from a defined population; 2) Identify potential risk factors for pain at each of these four sites; 3) Conduct standardized examinations and interviews for all respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 per respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 peer group) in order to: a) compare the rates of clinical signs and symptoms of temporomandibular disorders in cases and controls, and b) estimate the prevalence of specific clinical subtypes of TMD (myofascial pain, disc displacements, arthralgia, arthritis/arthrosis) using standardized examination methods and diagnostic algorithms. Examinations will be conducted in subjects' homes by Registered Dental Hygienists training and calibrated for reliability. The specific aims of Study 2 are: 1) Follow the cohort of 11 year old respondents from Study 1 (n= 1902) over a 3-year follow up period, using brief mail-in surveys and more extensive follow up data collection at 18 months and 3 years. Monitor rates of onset of TMD pain, headache, back pain and abdominal pain. Assess the impact of these pain problems in terms of interference with activities, use of medications and rates of health care use for pain; 2) Identify risk factors for onset of {{TMD pain, headache, back and abdominal pain}}> Hypothesized risk factors for all pains include: female gender, number of existing pain complaints, and other somatic symptoms, numbers of health care visits in the prior year, and psychological distress; in addition, we hypothesize that sexual maturity is a risk factor for onset of TMD pain and headache; 3) Estimate rates of offset and recurrence of each of the pain c9ompliants over the 3-year follow up period; and, 4) Conduct examinations of the incidence cases of TMD pain, using examination methods and diagnostic algorithms as described for Study 1, to estimate the prevalence of specific subtypes of TMD.