Risk Factors for Onset and Persistence of TMD

描述（由申请人提供）：TMD发病和持续的危险因素：肌源性颞下颌紊乱（TMD），伴或不伴关节痛，在美国人群中仅次于头痛，是最可能引起颅面疼痛和功能障碍的临床状况。在过去十年中，少数流行病学研究试图量化欧洲血统人群中TMD的发病率；然而，到目前为止，还没有一个调查小组进行了大规模的、假设驱动的、前瞻性的研究，旨在确定这种令人烦恼的疼痛障碍的发病和持续的生物、心理、社会和遗传风险因素。我们建议与国际公认的流行病学家、疼痛研究人员和遗传学家合作，对TMD的发病率进行全面、前瞻性队列研究。参与者将在四个研究机构和我们的数据协调中心（巴特尔纪念研究所）登记并进行前瞻性随访。我们的三个目标是：a)进行一项为期五年的前瞻性队列研究，从四个研究地点的主要民族和种族阶层中招募3200名最初没有tmd的个体，量化首次发病tmd的发病率；b)开展一项病例对照研究，招募200名在队列招募期间确定的慢性症状性TMD患者，这些患者的TMD病史使他们无法参与前瞻性研究；c)使用我们基于自己的研究和其他已发表的研究开发的TMD概念因果模型，确定两组TMD风险预测因子的个体和联合效应。我们的初步流行病学研究结果得出了一个中心假设，即疼痛放大和心理因素都受到遗传变异的影响，是影响TMD发病和持续的因果风险因素。我们提出的研究结果将确定TMD发病和持续的主要社会人口统计学、临床、生物学、心理和遗传风险因素。这样，我们将获得关于TMD发病机制的重要和新的信息，这将有助于开发基于证据的TMD药理学和行为干预措施。

DESCRIPTION (provided by applicant): Risk factors for onset and persistence of TMD: Myogenous temporomandibular disorder (TMD), with or without arthralgia, ranks second only to headache as the clinical condition most likely to cause craniofacial pain and dysfunction in the U.S. population. During the last decade, a small number of epidemiological studies have attempted to quantify the incidence of TMD in populations of European heritage; however, no investigative team to date has undertaken a large-scale, hypothesis-driven, prospective study designed to identify biopsychosocial and genetic risk factors for the onset and persistence of this vexing pain disorder. We propose to conduct a comprehensive, prospective cohort study of the incidence of TMD in collaboration with an internationally recognized group of epidemiologists, pain researchers, and geneticists. Participants will be enrolled and followed prospectively at four research institutions and by our Data Coordinating Center (Battelle Memorial Institute). Our three goals are to: a) undertake a five-year, prospective cohort study of 3200 initially TMD-free individuals recruited from major ethnic and racial strata at four study sites, quantifying incidence rates of first-onset-TMD; b) undertake a case-control study by recruiting 200 people with chronically symptomatic TMD identified during cohort recruitment whose history of TMD precludes them from the prospective study; c) to identify in both groups the individual and joint effects of predictors of TMD risk using a conceptual, causal model for TMD that we have developed based our own studies and other published research. Our preliminary epidemiological findings have led to the central hypothesis that pain amplification and psychological factors, both of which are influenced by genetic variants, represent causal risk factors that influence TMD onset and persistence. The outcomes of our proposed study will identify the primary socio-demographic, clinical, biological, psychological, and genetic risk factors for TMD onset and persistence. In so doing, we will obtain important and novel information regarding the etiopathogenesis of TMD, which will assist with the development of evidenced based pharmacological and behavioral interventions for TMD.