Simplifying the diagnostic process of TMJD pain for the general dentist

描述（由申请人提供）：疼痛的颞下颌肌和关节疾病（TMJD）是第二常见的肌肉骨骼疾病，影响了大约3000万美国人，估计每年的成本为40亿美元。对于普通牙医来说，诊断TMJD患者是具有挑战性的，因为身体上的TMJD疼痛诊断缺乏预后价值——不像心理上的TMJD因素，后者对治疗选择和结果预测有帮助。然而，对于颞下颌关节痛的心理社会评估并不是常规的，如果有的话，普通牙医使用，而是主要依赖于颞下颌关节痛的物理检查。因此，TMJD疼痛诊断需要有更好的临床应用，以提高普通牙医对更复杂的患者进行专科治疗的分诊。本应用的中心研究假设是，目前的物理TMJD疼痛评估包含未使用但有价值的“地理”TMJD疼痛信息，这些信息与TMJD相关的社会心理痛苦密切相关。使用这些信息将产生更有信息的TMJD疼痛诊断，从而降低TMJD患者心理社会评估的附加价值。颞下颌关节痛影响下颌、关节和太阳穴的几个部位，但通常也与牙齿、口腔、耳朵、颈部和头部疼痛有关。因此，颞下颌关节疼痛具有位置和分布成分；事实上，并不是所有的疼痛部位对治疗结果都有同等的重要性，更广泛的疼痛部位分布预示着不利的结果。目前，即使在诊断过程中收集到这种地理疼痛信息，除了用于区分疼痛的TMJ和肌肉位置外，也没有纳入诊断。本研究的目的是通过整合有关颞下颌关节痛的位置和分布的现有信息来改进现有的颞下颌关节痛诊断，并测试这些改进的诊断是否优于现有的预测社会心理困扰的诊断。使用应用最广泛的TMJD诊断系统，研究诊断标准，来自最近完成的多中心RDC/TMJD验证项目（633例TMJD病例，91例对照受试者）和来自两个德国中心的416例病例的数据，提供了一个成本效益高的机会，确定疼痛地理信息对TMJD诊断的贡献，使用创新的方法方法应用地理信息系统（GIS）分析。具体目的是：(i)利用TMJD疼痛定位数据的探索性数据分析，确定与新的TMJD疼痛诊断相对应的TMJD疼痛地理模式；（ii）测试TMJD疼痛地理模式是否比现有的TMJD疼痛诊断更能预测心理社会困扰的测量。这个应用程序是创新的，因为它将TMJD概念化为一种“地理”疼痛状况，应用了地理和公共卫生的复杂方法。这一应用具有重要意义，因为新的颞下颌关节痛诊断将为普通牙医提供一个简单的筛查工具，使用常规收集的颞下颌关节痛地理数据来识别患者的社会心理困扰，并避免对那些不需要的患者进行社会心理评估。

DESCRIPTION (provided by applicant): Painful temporomandibular muscle and joint disorders (TMJD) are the second most common musculoskeletal condition, affecting approximately 30 million Americans with an estimated annual cost of $4 billion. For the general dentist, diagnosing TMJD patients is challenging because the physical TMJD pain diagnoses lack prognostic value - unlike psychosocial TMJD factors, which are informative for treatment selection and as outcome predictors. However, the psychosocial assessment for TMJD is not routinely, if ever, used by the general dentist, who instead relies primarily on physical TMJD examination. Therefore, TMJD pain diagnoses need to have better clinical utility to improve the general dentist's triaging of more complex patients for specialty care. The central research hypothesis of this application is that the current physical TMJD pain assessment contains unused but valuable "geographic" TMJD pain information that correlates well with the psychosocial distress associated with TMJD. Using this information would produce a more informative TMJD pain diagnosis and consequently reduce the additional value of psychosocial assessment of TMJD patients. TMJD affect several locations in the jaw, joint, and temple, but often dental, oral, ear, neck, and head pains are also associated. Accordingly, TMJD pain has a location and distribution component; in fact, not all pain sites have equal importance for treatment outcomes, and a wider distribution of pain sites predicts unfavorable outcomes. Currently, even if this geographic pain information is collected during the diagnostic process, it is not incorporated into the diagnosis except for distinguishing between the TMJ versus muscle location of the pain. This study's objective is to improve existing TMJD pain diagnoses by integrating available information about the location and distribution of TMJD pain and testing whether these improved diagnoses are superior to existing ones in predicting psychosocial distress. Using the most widely applied TMJD diagnostic system, the Research Diagnostic Criteria for TMJD, data from the recently completed multi-center RDC/TMJD Validation Project (633 TMJD cases, 91 control subjects) and 416 cases from two German centers provide a cost- effective opportunity for determining the contribution of pain geography information for TMJD diagnosis using an innovative methodological approach applying geographic information systems (GIS) analyses. The specific aims are: (i) to identify patterns of TMJD pain geography corresponding to new TMJD pain diagnoses using exploratory data analysis of TMJD pain location data; and (ii) to test whether patterns of TMJD pain geography predict measures of psychosocial distress better than existing TMJD pain diagnoses. This application is innovative because it conceptualizes TMJD as a "geographic" pain condition, applying sophisticated methods from geography and public health. This application is significant because the new TMJD pain diagnoses will provide general dentists with a simple screening tool using routinely collected TMJD pain geography data to identify patients with psychosocial distress and to avoid psychosocial assessment for those who do not need it.