Risk Factors for Onset and Persistence of TMD

描述(由申请人提供)：TMD发病和持续的风险因素：在美国人群中，肌源性颞下颌关节紊乱病(TMD)，无论是否伴有关节痛，都是仅次于头痛的最有可能导致头面部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TMD在欧洲血统人群中的发病率；然而，到目前为止，还没有研究团队进行大规模的、假设驱动的前瞻性研究，旨在确定这种令人烦恼的疼痛障碍的发生和持续的生物、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)登记并进行前瞻性跟踪。我们的三个目标是：a)对从四个研究地点的主要民族和种族招募的3200名最初没有TMD的人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名在队列招募中发现的长期有症状的TMD患者进行病例对照研究，这些患者的TMD病史使他们无法参加前瞻性研究；c)利用我们根据自己的研究和其他已发表的研究开发的TMD的概念性因果模型，确定TMD风险预测因素在两组中的单独和联合影响。我们的初步流行病学发现导致了一个中心假设，即疼痛放大和心理因素都受到基因变异的影响，是影响TMD发病和持续的因果风险因素。我们建议的研究结果将确定TMD发病和持续的主要社会人口学、临床、生物、心理和遗传危险因素。通过这样做，我们将获得关于TMD病因的重要和新的信息，这将有助于TMD的循证药物和行为干预的发展。

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.