Hormonal Cycles in Women: Effects on TMD Pain & Symptoms

描述（由申请人提供）：疼痛定义为“与实际或潜在组织损伤相关的不愉快的感觉和情感体验。“因此，痛苦是不可避免的，是身心相互作用的产物。我们建议研究颞下颌关节紊乱病（TMD），一组涉及咀嚼肌和颞下颌关节疼痛的条件下，心灵和身体的相互作用。在社区中，这些疼痛问题在女性中的发生率大约是男性的两倍，并且在生育年龄期间患病率达到顶峰。TMD疼痛的病因尚不清楚，但心理压力、抑郁和其他躯体疾病的存在已被证明会影响这些疾病的病程。先前的研究表明，女性生殖激素也可能影响TMD疼痛。具体来说，正常骑自行车的女性TMD的经验不断上升的水平，TMD疼痛preferentially在一段时间内急剧下降的雌激素和显示峰值TMD疼痛在月经期间。有趣的是，TMD疼痛的第二个高峰出现在排卵期，这是另一个与快速雌激素变化相对应的阶段。这些数据表明TMD疼痛水平与月经周期阶段之间存在系统性关系。我们提出了两个相关的研究，以进一步探讨女性TMD疼痛的周期性。研究1将评估疼痛与生殖激素唾液水平的关系，以及与连续两个月经周期的女性TMD患者（n = 35）的心理压力，以及适当的相同规模的对照组-正常周期的女性发作性头痛和正常周期的控制女性没有TMD，头痛或其他慢性疼痛问题。研究1的目的是检验这一假设，即月经周期中临床疼痛和症状的增加与雌激素戒断和感知压力增加有关。研究2将操纵被假设为影响TMD疼痛的行为和激素因素，比较：1）旨在抑制月经和稳定激素环境的连续口服避孕药干预，2）专注于月经周期中TMD症状的时间生物学并定时的自我管理干预，以及3）通常的自我管理干预不定时生物事件。这项临床试验的目的是阐明女性TMD疼痛和症状周期性的机制，以及确定哪种治疗方式能最大程度地改善TMD疼痛和症状。因此，拟议中的研究将提供重要的和独特的信息，在女性疼痛感知的生物和心理社会方面的关系。

DESCRIPTION (provided by applicant): Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." Thus, pain is, inevitably, a product of the interaction of mind and body. We propose to study the interactions of mind and body related to temporomandibular disorders (TMD), a group of painful conditions involving the muscles of mastication and the temporomandibular joint. These pain problems are about twice as common in women as in men in the community, and prevalence peaks during the reproductive years. The etiology of TMD pain is unknown, but psychological stress, depression and the presence of other somatic complaints have been shown to influence the course of these disorders. Prior research suggests that female reproductive hormones may also influence TMD pain. Specifically, normally cycling women with TMD experience rising levels of TMD pain pre-menstrually during a time of precipitous drop in estrogen and show peak TMD pain during menses. Interestingly, a secondary peak of TMD pain occurs at about the time of ovulation, another phase corresponding to rapid estrogen change. These data demonstrate a systematic relationship between levels of TMD pain and phases of the menstrual cycle. We propose two related studies to further investigate the cyclic nature of TMD pain in women. Study 1 will assess the relationship of pain to salivary levels of reproductive hormones and to psychological stress across two consecutive menstrual cycles for female TMD patients with normal menstrual cycles (n = 35), as well as appropriate comparison groups of the same size --normally cycling women with episodic headache and normally cycling control women without TMD, headache or other chronic pain problems. Study 1 is designed to test the hypothesis that increases in clinical pain and symptoms across the menstrual cycle are associated with estrogen withdrawal and increased perceived stress. Study 2 will manipulate the behavioral and hormonal factors that are hypothesized to influence TMD pain, comparing the effects of: 1) a continuous oral contraceptive intervention designed to suppress menses and stabilize the hormonal environment, 2) a self-management intervention focused on and timed to the chronobiology of TMD symptoms across the menstrual cycle, and 3) a usual self-management intervention not timed to biological events. The aims of this clinical trial are to shed light on the mechanisms underlying the cyclic nature of TMD pain and symptoms in women, as well as to determine which treatment modality results in the greatest improvement in TMD pain and symptoms. Thus, the proposed studies will provide important and unique information on the relationships of biological and psychosocial aspects of pain perception in women.