Hormonal Cycles in Women: Effects on TMD Pain & Symptoms

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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.