Biobehavioral Pain Management in TMD

描述（由申请人提供）：颞下颌关节紊乱病（TMD）是一种普遍且昂贵的公共卫生挑战，影响了大量其他健康成人。然而，人们对它们的了解仍然很少。疼痛处理系统的外周和中枢改变导致TMD疼痛的严重程度和持续性存在较大的个体差异。这种复杂性和异质性要求一个全面的，多方面的方法，系统地确定因果关系和机械联系的临床疼痛。疼痛相关的灾难化（CAT）和睡眠连续性障碍（SCD）是TMD和其他特发性疼痛状况的两个可改变的风险因素，影响疼痛放大和临床疼痛的原伤害感受机制。这项研究旨在探讨减少这些危险因素是否会改变TMD患者的疼痛调节系统和疼痛诱发的炎症活动。符合TMD的RDC标准和研究入选标准的女性将随机接受认知疗法治疗灾难化，行为疗法治疗睡眠连续性障碍，或TMD疾病教育。除了全面的临床评估外，还将在随机化之前和之后完成睡眠的多导睡眠图测量和疼痛敏感性和调节系统、炎症活动、自主活动和肾上腺皮质功能的实验室测量。CAT和SCD的减少预计将减少疼痛诱发的炎症活动并改善疼痛调节，这预计将先于临床TMD疼痛的减少。随着PSG和日记的加入，我们的方法使我们能够研究CAT和SCD之间的潜在相互作用。具体来说，我们将研究是否减少CAT和SCD，以减少睡眠中的觉醒，以及这些影响是否是由治疗特异性减少睡前觉醒介导的。由于睡眠障碍和灾难化都是可改变的风险因素，我们的研究结果有望促进这种慢性疾病的新治疗和预防方法的发展，这种疾病影响了数百万美国人的成年生活。

DESCRIPTION (provided by applicant): Temporomandibular joint disorders (TMD) are a prevalent and costly public health challenge, affecting a large number of otherwise generally healthy adults. Yet they remain poorly understood. Peripheral and central alterations in pain processing systems contribute to the large individual differences seen in the severity and persistence of pain in TMD. This complexity and heterogeneity mandates a comprehensive, multidimensional approach that systematically determines causal and mechanistic linkages to clinical pain. Pain-related catastrophizing (CAT) and sleep continuity disturbance (SCD) are two modifiable risk factors for TMD and other idiopathic pain conditions that influence the pronociceptive mechanisms underlying pain amplification and clinical pain. The proposed study examines whether reducing these risk factors alters pain modulatory systems and pain-evoked inflammatory activity in patients with (TMD). Women meeting RDC criteria for TMD and study entry criteria will be randomized to receive cognitive therapy for catastrophizing, behavioral therapy for sleep continuity disturbance, or TMD disease education. In addition to a comprehensive clinical assessment, polysomnographic measures of sleep and laboratory measures of pain sensitivity and modulatory systems, inflammatory activity, autonomic activity, and adrenocortical function will be completed before after randomization. Reductions in CAT and SCD are expected to reduce pain-evoked inflammatory activity and improve pain modulation, which are expected to precede reductions in clinical TMD pain. With the inclusion of PSG and diaries, our methods allow us to examine potential interplay between CAT and SCD. Specifically, we will examine whether reductions in CAT and SCD to reduce arousal during sleep and whether these effects are mediated by treatment-specific reductions in pre-sleep arousal. Because both sleep disturbance and catastrophizing are modifiable risk factors, our findings promise to promote the development of new treatments and prophylactic approaches for this chronic illness that affects millions of Americans in the prime of their adult lives.