AN EVALUATION AND TREATMENT STUDY OF TMD

描述：（来自申请）过去资助的赠款项目的主要目标 是为了确定急性颞下颌关节紊乱病 (TMD)这些事件很可能会演变成长期问题。与伟大的 经济成本和传统的慢性TMD患者的不良结局， 对于有效治疗老年患者变得越来越重要。 急性状态，以防止这些更慢性的残疾问题。结果 这个过去的项目中明确分离出的预测慢性病的风险因素。作为 作为这些重要发现的延伸，我们现在有了一个统计算法， 可用于识别急性TMD患者， 早期干预，以防止慢性化。本拟议项目 将涉及对大量急性TMD患者的评估， 筛选出那些有“高风险”发展成慢性病的患者。 这些高危患者将被随机分配到两组中的一组 (30患者/组）：早期干预组或非干预组。 干预程序将仿照发现的最 在我们过去的R 01资助项目中有效-生物反馈/认知组合 行为治疗法随后将进行为期一年的后续评价， 进行评估以评估疼痛、残疾等重要结果， 复发率和卫生保健利用率。据推测， 在急性期进行干预可防止慢性 残疾。此外，作为对以前赠款项目的复制， 结果，非干预组患者将与 人口统计学匹配队列（n=60）的初始评估急性TMD患者 没有显示出“高风险”特征的人。据推测，“高 风险”非干预组患者将表现出更高的疼痛率， 相对于“低风险”患者，一年后的残疾。这些 结果将对有效的早期干预产生重大影响， 从而为这种普遍的疼痛问题带来显著的卫生保健成本节约。 最后，本拟议项目的另一个目标是 评价疼痛和疼痛之间相互作用的潜在启发性理论， Mezack（1996）最近提出的应力。目前拟议的项目将 开始评估这个理论的潜在有效性通过评估一个关键 生物指标（皮质醇），梅尔扎克建议密切参与 压力与疼痛的相互作用过程更好地理解这样一个 机制可能会产生更有效的评估和治疗 治疗慢性疼痛综合征的方法，如TMD。

DESCRIPTION: (from the application) A major goal of a past funded grant project was to identify useful predictors of when acute temporomandibular disorder (TMD) incidents were likely to develop into chronic problems. With the great economic cost and traditionally poor outcomes among chronic TMD patients, it has become increasingly more important to effectively treat patients in the acute state in order to prevent these more chronic disability problems. Results of this past project clearly isolated risk factors that predict chronicity. As an extension of these important findings, we now have a statistical algorithm that can be used to identify acute TMD patients who are prime candidates for early intervention in order to prevent chronicity. The present proposed project will involve the assessment of a large cohort of acute TMD patients in order to screen out those patients who are at "high risk" for developing chronicity. These high-risk patients will then be randomly assigned to one of two groups (30 patients/group): an early intervention group or a non-intervention group. The intervention procedure will be modeled after that found to be most effective in our past R01 grant project - a combined biofeedback/cognitive behavioral treatment approach. One-year follow-up evaluations will subsequently be conducted in order to assess important outcomes such as pain, disability, relapse, and health-care utilization rates. It is hypothesized that early intervention at the acute stage will prevent the development of chronic disability. In addition, as a replication of the previous grant project results, the non-intervention group patients will be compared to a demographically matched cohort (n=60) of initially assessed acute TMD patients who do not display the "high risk" profile. It is hypothesized that the "high risk" non-intervention group patients will demonstrate higher rates of pain and disability at one year relative to the "low risk" profile patients. These results will have major implications for effective early intervention and result in significant health-care cost savings for this prevalent pain problem. Finally, an additional goal of this present proposed project will be the evaluation of a potentially heuristic theory of the interaction of pain and stress recently proposed by Mezack (1996). The present proposed project will begin evaluating the potential validity of this theory by assessing a key biological index (cortisol) that Melzack proposes to be intimately involved in the stress-pain interaction process. The better understanding of such a mechanism can potentially yield even more effective assessment and treatment approaches for chronic pain syndromes such as TMD.