TMD

这个子项目是许多研究子项目中利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 颞下颌关节功能障碍(TMD)是一种广泛存在的慢性疼痛症状。已经开发了许多针对TMD的心理社会治疗方法，并对大多数患者取得了成功。然而，这些治疗方法实现其效果的机制并没有得到很好的说明。目前这项研究的总体目标是评估治疗的认知、行为和生理机制，以发现是什么导致了这种疾病的治疗收益。为此，我们将为患者提供简短的认知-行为治疗，旨在最大限度地提高适应性认知和行为，同时使用经验采样范式定期监测他们的疼痛、思想、感觉和应对行为。具体而言，目标如下： 1.评估将标准夹板疗法与集中认知-行为疗法(STD+CBT)相结合的简单疗法对TMD患者疼痛和心理社会功能的影响，该疗法旨在最大限度地提高应对自我效能，并在应对特定疼痛相关情况时将灾难降至最低。 H1。据推测，接受短暂认知行为治疗的患者将比一组接受基于夹板治疗而不接受认知行为治疗的标准保守治疗的患者有更好的结果。 2.确定哪些情境因素和性格因素对TMD治疗后的总体适应和疼痛感觉有预测作用。 H2。预计性格因素和每天四次测量的情景因素都将在预测治疗后的适应和疼痛方面发挥作用。 3.明确治疗后患者的情绪、认知和应对行为发生了哪些变化。 H3.据预测，与STD患者相比，STD+CBT治疗的患者将表现出更多的特定应对行为，改善的情绪，更高的疼痛控制自我效能，以及实时测量的灾难频率和强度，这些变化将与治疗结果相关。 4.确定治疗本身对生理应激和细胞免疫指标的影响。 H4.预计在随访点上，STD+CBT组的受试者的血浆皮质醇水平和促炎细胞因子水平将低于STD受试者。 5.确定自我效能等与治疗相关的情境过程变量的变化是否与皮质醇和细胞因子水平的变化有关，这表明心理社会治疗的部分作用是通过改变HPA轴和细胞介导的炎症过程。 H5。假设应对行为的改变、情境自我效能感和灾害性的改变将与治疗前后皮质醇和细胞因子水平的变化相关。 这些结果可能表明需要解决哪些类别的变量来加强对TMD患者的治疗，并开始查明TMD治疗改善的真正积极机制。如果这些机制能够被成功识别，这将对开发更有效的TMD和相关疾病的治疗方案具有重要意义。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Temporomandibular joint dysfunction (TMD)is a widespread chronic pain condition. A number of psychosocial treatments for TMD have been developed that have been successful for a majority of patients. The mechanisms by which these treatments achieve their effects, however, are not well specified. The general goal of the current study is to evaluate the cognitive, behavioral, and physiological mechanisms of treatment to discover what accounts for treatment gains in this disorder. To do this we will deliver to patients a brief cognitive-behavioral treatment designed to maximize adaptive cognitions and behaviors, while periodically monitoring their pain, thoughts, feelings, and coping behaviors using an experience sampling paradigm. Specifically the aims are as follows: 1. To evaluate the effects on TMD patients' pain and psychosocial functioning of a brief treatment that combines a standard splint therapy with a focused cognitive-behavioral program (STD+CBT) intended to maximize coping self-efficacy and minimize catastrophization in response to specific pain-related circumstances. H1. It is hypothesized that patients exposed to the brief cognitive behavior treatment will have better outcomes than will a group of patients given a standard conservative treatment based on splint therapy without cognitive-behavioral treatment. 2. To determine what situational factors and dispositional factors are predictive of general adaptation and pain perception following TMD treatment. H2. It is expected that both dispositional factors, and situational factors measured four times daily, will play a role in predicting adaptation and pain following treatment. 3. To determine specifically what moods, cognitions and coping behaviors are changed as a result of treatment. H3. It is predicted that patients in the STD+CBT treatment will exhibit increased numbers of specific coping behaviors, improved mood, higher self-efficacy for pain control, and decreased frequency and intensity of catastrophization as measured in real time, as compared to STD patients, and that these changes will be associated with treatment outcome. 4. To determine what effects treatment per se may have on measures of physiological stress and cell-mediated immunity. H4. It is expected that, at the follow-up points, subjects in the STD+CBT group will have lower levels of plasma cortisol and lower levels of proinflammatory cytokines than will the STD subjects. 5. To determine whether changes in treatment-related situational process variables such as self-efficacy are associated with changes in cortisol and cytokine levels, suggesting that psychosocial treatments act partly by altering HPA axis and cell-mediated inflammatory processes. H5. It is hypothesized that changes in number of coping behaviors used and changes in situational self-efficacy and catastrophization will be correlated with changes in cortisol and cytokine levels from pre-to post-treatment. The results may indicate what classes of variables need to be addressed to enhance treatment for TMD sufferers, and start to pinpoint the true active mechanisms accounting for improvement in TMD treatment. If these mechanisms can be successfully identified it would have implications for the development of more effective treatment programs for TMD and for related disorders.