BIOBEHAVIORAL METHODS IN TMD

提出了两项研究，其总体目标是证明 区分心理健康非功能障碍的有用性(研究1) 和(研究2)功能障碍的慢性疼痛患者进行治疗 TMD的决策。TMD指的是一组以疼痛为特征的障碍 和咀嚼肌肉的压痛和/或 颞下颌关节(TMJ)，常伴有张口受限 通过下颌路径的偏差，以及点击、弹出或咬合TMJ 听起来。功能性慢性疼痛被定义为慢性-复发性疼痛 中等强度--限制活动的重度强度。功能失调性慢性 疼痛与情绪障碍、高发病率有关 主要社会角色的行为和表现受损。 研究1：功能性TMD患者的最低限度自我护理干预。一个 随机临床试验将评估最低限度的治疗 注册牙科卫生员TMD Care提供的条件 使用自学材料和当前概念的经理 治疗慢性疼痛的自我护理方法如下： 对心理功能性TMD的治疗与常规治疗一样有效 病人。功能性TMD患者被定义为受 他们的TMD状况，报告的轻-中度疼痛与 活动受限，过度依赖医疗保健或心理 骚乱。 研究2.认知行为疗法(CBT)治疗慢性TMD功能障碍 疼痛患者。一项随机临床试验将评估一项 独特设计的强化CBT条件{{(n=77)}}与通常的 护理比单独使用常规治疗更有效 改善正常下巴使用和休息时的TMD疼痛和不适，如 以及改善残疾、抑郁、躯体化和过度 卫生保健资源的利用。CBT干预协调 治疗牙医与临床心理学家TMD的参与 疼痛管理专家，并强调生物心理社会解释 TMD的模型、体征监测和应对技巧 禁用慢性疼痛的各个方面，以及患者管理的自助小组 提供持续的教育、支持和更少的医疗保健。 研究L和2将分别在基线、治疗后对患者进行评估 干预，并使用共享措施进行6个月和12个月的随访 评估临床状态、疼痛和功能失调性慢性疼痛分级， 心理社会功能和应对疼痛及其他生理问题的策略 症状。 我们的长期目标是证明补充临床TMD 用生物行为分类和治疗进行分类和治疗 治疗产生了安全的有效管理TMD的方法， 促进现实的预期，减少医疗保健的使用 时间到了。

Two studies are proposed whose overall goal is to demonstrate the usefulness of distinguishing (Study 1) psychosocially non-dysfunctional and (Study 2) dysfunctional chronic pain patients when making treatment decisions for TMD. TMD refers to a set of disorders characterized by pain and tenderness in the muscles of mastication and/or the temporomandibularjoint (TMJ), limitations of jaw opening often accompanied by deviations in mandibular path, and clicking, popping or grating TMJ sounds. Dysfunctional chronic pain is defined as chronic-recurrent pain of moderate-severe intensity that limits activities. Dysfunctional chronic pain is associated with emotional disturbance, elevated rates of illness behavior and impaired performance of major social roles. Study 1. Minimal self-care intervention for functional TMD patients. A randomized clinical trial will evaluate whether a minimal treatment condition {{(n=74)}} delivered by a registered dental hygienist TMD Care Manager using self-instructional materials and current concepts and methods for self-care for the management of chronic pain, will be as effective as usual treatment {{(n=74)}} for psychosocially functional TMD patients. Functional TMD patients are defined as minimally impacted by their TMD condition, reporting low-moderate pain which is not associated with activity limitation, undue reliance on health care or psychological disturbance. Study 2. Cognitive-behavioral treatment (CBT) of dysfunctional chronic TMD pain patients. A randomized clinical trial will evaluate whether a uniquely designed intensive CBT condition {{(n=77)}} integrated with usual care is more effective than usual treatment alone {{(n=77)}} in ameliorating TMD pain and discomfort during normal jaw use and at rest, as well as ameliorating disability, depression, somatization and excessive use of health care resources. The CBT intervention coordinates the participation of the treating dentist with a clinical psychologist TMD Pain Management Specialist, and emphasizes a biopsychosocial explanatory model, skills for monitoring signs and symptoms of TMD and for coping with disabling aspects of chronic pain, and patient-managed self-help groups to provide ongoing education, support, and less health care. Studies l and 2 will each evaluate patients at baseline, post- intervention, and 6- and 12-month follow-up using shared measures to assess clinical status, pain and grade of dysfunctional chronic pain, psychosocial functioning and coping strategies for pain and other physical symptoms. Our long range goal is to demonstrate that complementing clinical TMD classification and treatment with biobehavioral classification and treatment yields methods for effective management of TMD which are safe, facilitate realistic expectations and require less health care use over time.