MENSTRUAL CYCLE EFFECTS ON TMD PAIN AND OTHER SYMPTOMS

描述：颞下颌关节紊乱病(TMD)是肌肉骨骼疼痛 以咀嚼肌肉疼痛和/或 颞下颌关节。这些疼痛问题的常见程度大约是 在社区中，妇女与男子一样，流行率在 生育年限。约80%的患者在三级护理中接受治疗 布景都是女性。研究人员提出了一项为期5年的临床研究计划 流行病学和实验研究，以检查可能的相互作用 荷尔蒙状况、其他性别因素对疼痛敏感性的影响 非TMD躯体症状和心理困扰对TMD疼痛的影响 在女人身上。研究1将评估临床TMD自我报告的变化 与荷尔蒙相关的疼痛、其他身体症状和心理社会状态 正常连续三个排卵月经周期的状况 骑自行车的女性TMD患者以及适当的对照组(男性 TMD患者，使用口服避孕药的女性TMD患者和正常 骑自行车无痛女性对照组)。研究2和3将评估 对标准化实验疼痛刺激的反应的变异性 临界点(月经、排卵、黄体中期和黄体晚期/经前 在女性TMD病例中，跨越连续三个排卵周期)和 适当的控制，以确定可变性和水平的程度 疼痛体验可能归因于女性性别，荷尔蒙状况， 经期疼痛(即痛经)和/或 临床上存在TMD疼痛。研究4评估临床疼痛，疼痛在 触诊对咀嚼肌和颞下颌关节的反应 每三个月的关节、心理社会变量和激素状况 在TMD病例和年龄匹配的对照组中，怀孕和产后也是如此。 最后，研究5比较了荷尔蒙水平、疼痛报告和心理 仅诊断为关节疼痛的女性月经周期的影响因素 只被诊断为肌肉疼痛的女性。因此，拟议的研究将：1) 提供有关临床病程的重要描述性信息 月经周期和怀孕期间的疼痛；2)说明 临床疼痛、全身性疼痛敏感性、 心理状态、性别和荷尔蒙状况；以及3)探索 中枢或外周机制可能与疼痛激素有关 两性关系。

DESCRIPTION: Temporomandibular disorders (TMD's) are musculoskeletal pain conditions characterized by pain in the muscles of mastication and/or the temporomandibular joint. These pain problems are about twice as common in women as in men in the community, and prevalence peaks during the reproductive years. About 80 percent of patients treated in tertiary care settings are women. The investigators propose a 5-year program of clinical epidemiologic and experimental research to examine the possible interactive influences of hormonal status, other gender factors in pain sensitivity, the presence of non-TMD somatic symptoms and psychological distress on TMD pain in women. Study 1 will assess variations in self report of clinical TMD pain, other physical symptoms and psychosocial state in relation to hormonal status across three consecutive ovulatory menstrual cycles for normally cycling female TMD patients, as well as appropriate comparison groups (male TMD patients, female TMD patients who use oral contraceptives and normally cycling pain-free females controls). Studies 2 and 3 will assess variability in responses to standardized experimental pain stimuli at critical points (menses, ovulatory, mid-luteal and late luteal/premenstrual phases) across three consecutive ovulatory cycles in female TMD cases and appropriate controls, to ascertain the extent to which variability and level of pain experience may be attributable to female gender, hormonal status, experience of pain during the menstrual period (i.e., dysmenorrhea) and/or presence of clinical TMD pain. Study 4 assesses clinical pain, pain in response to palpation of muscles of mastication and the temporomandibular joint, psychosocial variables and hormonal status during each trimester of pregnancy, as well as postpartum in TMD cases and age-matched controls. Finally, Study 5 compares hormone levels, pain report and psychological factors over the menstrual cycle in women diagnosed with joint pain only and women diagnosed only with muscle pain. Thus, the proposed studies will: 1) provide important descriptive information concerning the course of clinical pain across the menstrual cycle and during pregnancy; 2) illuminate relationships between clinical pain, generalized pain sensitivity, psychological state, gender and hormonal status; and 3) explore whether central or peripheral mechanisms may be involved in pain-hormone relationships.