Mechanisms of myofascial TMD pain: endogenous pain modulation and beyond

肌筋膜 TMD 疼痛的机制：内源性疼痛调节及其他

• 批准号: 10448498
• 负责人: Vivian Santiago
• 金额: $ 15.38万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10448498
• 关键词: Address; Affect; American; Animal Experimentation; Applications Grants; Area; Arthralgia; Award; Characteristics; Classification; Clinical Research; Communities; Control Groups; Data Analyses; Data Set; Dental; Development; Disease; Epidemiologist; Esthesia; Failure; Frequencies; Functional disorder; Heterogeneity; Human; Human Subject Research; Iatrogenesis; Individual; Joints; Laboratories; Left; Maintenance; Masticatory muscles; Measures; Mentored Research Scientist Development Award; Mentorship; Methods; Muscle; Musculoskeletal Pain; Myofascial Pain Syndromes; Nature; Nervous System Physiology; Neuraxis; Neurobiology; Neurosciences; Nociception; Oral; Pain; Pain Research; Pain management; Pathology; Patients; Pattern; Peripheral; Phase; Phenotype; Preparation; Psychophysics; Public Health; Research; Research Personnel; Research Training; Role; Sampling; Science; Self Management; Sensory; Sleep; Source; Stimulus; Syndrome; System; Taxonomy; Temporomandibular Joint; Temporomandibular Joint Disorders; Test Result; Testing; Time; Training; Translational Research; Woman; base; case control; central pain; chronic pain; chronic painful condition; comorbidity; conditioned pain modulation; cost; craniofacial; design; dual diagnosis; experience; human subject; improved; innovation; interest; meetings; opioid epidemic; pain patient; response; stem; theories

PROJECT SUMMARY/ABSTRACT Most Americans experience some form of musculoskeletal pain in their lifetime and painful myofascial Temporomandibular Disorder (mTMD) is one condition affecting at least 10% of community women. The causes of mTMD are poorly understood. Patients are often left with expensive or invasive treatments for which evidence of efficacy is mixed at best. Persistent mTMD is increasingly considered a chronic pain condition, with a presumed dysfunction in a central pain mechanisms such as in endogenous pain modulation. Despite increasing research, including use of quantitative sensory testing, conclusive evidence of pathology has not emerged. Given the complexity of human neurobiology, including the inherently dynamic and stimulus- dependent nature of endogenous pain modulation, lack of progress may be due to unmeasured confounding. This proposal will use an innovative approach to address potential confounding introduced by phenotypic heterogeneity and nociceptive burden. First, phenotypes of mTMD based on presence of joint pain, i.e. muscle only-based pain (M-pain) versus both muscle and joint-based pain (MJ-pain) will be refined to determine case groups. Second, unmeasured nociceptive input from other potential sources, (i.e., nociceptive burden) will be addressed by examining both comorbidities that represent peripheral sensitization and laboratory-based sleep masticatory muscle activity. To conduct a more valid examination of the role of endogenous pain modulation dysfunction in mTMD, the following aims will be examined first in a completed case-control dataset of women, and second in planned pilot research: (1) Explore characteristics of temporomandibular joint pain to classify mTMD patients as M-pain or MJ-pain and examine patterns of comorbid disorders; (2) Compare facilitatory pain modulation among the M-pain, MJ-pain and control groups; and (3) Compare inhibitory pain modulation among M-pain, MJ-pain and control groups. To accomplish the proposed research and develop a research agenda that can uncover mechanisms of mTMD, the present application for a Mentored Research Scientist Development Award to Promote Diversity in Dental, Oral and Craniofacial Research Workforce (K01) proposes to advance the expertise of a trained psychiatric epidemiologist in four areas: (1) chronic pain taxonomy (clinical and research); (2) neuroscience of pain and translational research; (3) psychophysics of pain; and secondarily (4) systems science approaches for the study of chronic pain. The proposed research and training will result in submission of an R01 grant proposal on mechanisms of myofascial pain onset and maintenance in human subjects.

项目总结/摘要 大多数美国人在一生中都会经历某种形式的肌肉骨骼疼痛， 颞下颌关节紊乱病（mTMD）是一种影响至少10%的社区妇女的疾病。的 mTMD的病因知之甚少。患者往往只能接受昂贵或侵入性的治疗， 疗效的证据充其量是好坏参半。持续性mTMD越来越多地被认为是一种慢性疼痛状况， 推测中枢疼痛机制（例如内源性疼痛调节）功能障碍。尽管 越来越多的研究，包括使用定量感觉测试，病理学的确凿证据还没有 涌现考虑到人类神经生物学的复杂性，包括内在的动力和刺激- 内源性疼痛调节的依赖性，缺乏进展可能是由于未测量的混杂。 该提案将使用一种创新方法来解决由表型 异质性和伤害性负担。首先，基于关节疼痛（即肌肉疼痛）存在的mTMD表型 将对仅基于疼痛（M-疼痛）与基于肌肉和关节疼痛（MJ-疼痛）进行细化，以确定病例 组第二，来自其他潜在来源的未测量的伤害性输入（即，伤害性负担）将是 通过检查代表外周致敏和实验室睡眠的合并症来解决 咀嚼肌活动对内源性疼痛调节的作用进行更有效的检查 mTMD的功能障碍，以下目标将首先在一个完整的女性病例对照数据集中进行检查， 第二，拟开展的先导性研究：（1）探讨颞下颌关节疼痛的特点， mTMD患者作为M-疼痛或MJ-疼痛，并检查共病疾病的模式;（2）比较易化性 M-pain、MJ-pain和对照组之间的疼痛调制;（3）比较抑制性疼痛调制 M-pain组、MJ-pain组和对照组。完成拟定的研究并开展研究 议程，可以揭示mTMD的机制，目前的应用指导研究科学家 促进牙科、口腔和颅面研究工作人员多样性发展奖（K 01）建议 在以下四个方面提高训练有素的精神病学流行病学家的专业知识：（1）慢性疼痛分类 （临床和研究）;（2）疼痛的神经科学和转化研究;（3）疼痛的心理物理学;以及 其次（4）慢性疼痛研究的系统科学方法。拟议的研究和培训 将导致提交R 01拨款建议的机制，肌筋膜疼痛的发病和维持， 人类实验对象