Risk Factors for Onset and Persistence of TMD

描述（由申请人提供）：TMD发作和持续的风险因素：肌源性颞下颌关节紊乱病（TMD），伴或不伴关节痛，在美国人群中仅次于头痛，是最可能导致颅面疼痛和功能障碍的临床疾病。在过去的十年中，少数流行病学研究试图量化的发病率TMD的欧洲遗产的人口，但是，迄今为止，没有调查小组进行了大规模的，假设驱动的，前瞻性的研究，旨在确定生物心理社会和遗传危险因素的发病和持续性的这种令人烦恼的疼痛障碍。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的发病率进行一项全面的前瞻性队列研究。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）进行招募和前瞻性随访。我们的三个目标是：a）对从四个研究地点的主要种族和种族阶层招募的3200名最初无TMD的个体进行为期五年的前瞻性队列研究，量化首发TMD的发病率; B）通过招募200名在队列招募期间确定的患有慢性症状的TMD的人进行病例对照研究，这些人的TMD病史将他们排除在前瞻性研究之外; c）使用我们根据自己的研究和其他已发表的研究开发的TMD概念性因果模型，在两组中确定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导致了一个中心假设，即疼痛放大和心理因素，这两者都受到遗传变异的影响，代表了影响TMD发病和持续性的因果风险因素。我们建议的研究结果将确定主要的社会人口统计学，临床，生物，心理和遗传的风险因素，TMD的发病和持续性。通过这样做，我们将获得有关TMD发病机制的重要和新颖的信息，这将有助于发展基于证据的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.