Biobehavioral Pain Management in TMD

TMD 的生物行为疼痛管理

• 批准号: 8323319
• 负责人: JENNIFER A HAYTHORNTHWAITE
• 金额: $ 75.34万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-22 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8323319
• 关键词: Adult; Affect; American; Arousal; Behavior Therapy; Biological Process; Chronic; Chronic Disease; Clinical; Clinical assessments; Cognitive; Cognitive Therapy; Comorbidity; Data; Development; Dimensions; Disease; Education; Emotional; Equilibrium; Exacerbated Insomnia; Fostering; Functional disorder; Heterogeneity; Individual Differences; Inflammatory; Inflammatory Response Pathway; Laboratories; Link; Longitudinal Studies; Measures; Mediating; Mediation; Mental Depression; Methods; Neurobiology; Outcome; Pain; Pain Disorder; Pain management; Pathway interactions; Patients; Pattern; Peripheral; Polysomnography; Population; Process; Prophylactic treatment; Public Health; Randomized; Relative (related person); Risk Factors; Severities; Sleep; Sleep disturbances; Sleeplessness; System; Temporomandibular Joint Disorders; Temporomandibular joint disorder pain; Thinking; Variant; Woman; biobehavior; chronic pain; diaries; experience; follow-up; health care service utilization; heart rate variability; improved; indexing; meetings; modifiable risk; neurobiological mechanism; prospective; psychological distress; research study; response; trait

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.

描述（由申请人提供）：颞下颌关节疾病 (TMD) 是一种普遍存在且代价高昂的公共卫生挑战，影响着大量原本健康的成年人。然而，人们对它们仍然知之甚少。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时间存在巨大的个体差异。这种复杂性和异质性需要一种全面的、多维的方法来系统地确定与临床疼痛的因果关系和机制联系。疼痛相关灾难化 (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危险因素，影响疼痛放大和临床疼痛的促伤害感受机制。这项拟议的研究旨在探讨减少这些危险因素是否会改变TMD（TMD）患者的疼痛调节系统和疼痛诱发的炎症活动。符合 RDC TMD 标准和研究进入标准的女性将被随机接受灾难化认知治疗、睡眠连续性障碍行为治疗或 TMD 疾病教育。除了全面的临床评估之外，随机化之前还将完成睡眠多导睡眠图测量以及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，预计这将先于临床 TMD 疼痛的减少。通过纳入 PSG 和日记，我们的方法使我们能够检查 CAT 和 SCD 之间潜在的相互作用。具体来说，我们将检查 CAT 和 SCD 的减少是否会减少睡眠期间的觉醒，以及这些影响是否是通过治疗特异性减少睡前觉醒来介导的。由于睡眠障碍和灾难化都是可改变的危险因素，因此我们的研究结果有望促进针对这种慢性疾病的新疗法和预防方法的开发，这种慢性疾病影响着数百万处于成年时期的美国人。