TMD

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。列出的机构是 研究中心，而研究中心不一定是研究者所在的机构。 颞下颌关节功能障碍（TMD）是一种广泛存在的慢性疼痛疾病。已经开发了许多TMD的心理社会治疗方法，这些方法对大多数患者都是成功的。然而，这些治疗达到其效果的机制并没有很好地说明。目前研究的总体目标是评估治疗的认知，行为和生理机制，以发现这种疾病的治疗收益。为此，我们将为患者提供一个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，感受和应对行为。具体目标如下： 1. 评价标准夹板疗法与集中认知行为计划（STD+CBT）相结合的短期治疗对TMD患者疼痛和心理社会功能的影响，旨在最大限度地提高应对自我效能，并最大限度地减少对特定疼痛相关情况的灾难化。 H1。据推测，患者暴露于短期认知行为治疗将有更好的结果比一组患者给予标准的保守治疗的基础上夹板治疗没有认知行为治疗。 2. 确定哪些情境因素和性格因素可预测TMD治疗后的一般适应和疼痛感知。 H2。预计性格因素和情景因素每天测量四次，将在预测治疗后的适应和疼痛方面发挥作用。 3. 明确治疗后哪些情绪、认知和应对行为发生了变化。 H3.据预测，与STD患者相比，STD+CBT治疗的患者将表现出特定应对行为数量增加、情绪改善、疼痛控制自我效能提高以及灾难化频率和强度降低（如在真实的时间内测量的），并且这些变化将与治疗结果相关。 4. 确定治疗本身可能对生理应激和细胞介导的免疫措施产生的影响。 H4。预计在随访时，STD+CBT组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. 确定治疗相关的情境过程变量（如自我效能）的变化是否与皮质醇和细胞因子水平的变化相关，这表明心理社会治疗部分通过改变HPA轴和细胞介导的炎症过程起作用。 H5。据推测，在一些应对行为的使用和变化的情景自我效能和灾难化的变化将与皮质醇和细胞因子水平的变化，从治疗前到治疗后。 这些结果可能表明，需要解决哪些类别的变量，以加强对TMD患者的治疗，并开始查明真正的积极机制，占改善TMD治疗。如果这些机制能够被成功地确定，这将对TMD和相关疾病更有效的治疗方案的发展产生影响。

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.