TMD LONGITUDINAL STUDIES: CLINICAL/CHRONIC PAIN SYNDROME

本申请要求继续TMD纵向研究项目：临床/慢性疼痛综合征。{{总体目标是开展多学科研究，旨在了解发病过程，并适当护理慢性，复发性疼痛状况，特别强调颞下颌疾病（TMD）。该项目将继续关注TMD作为一种临床实体，疼痛患者对疼痛问题的适应以及疼痛患者与医疗保健系统的互动。研究策略的一个组成部分将继续与TMD与其他常见慢性疼痛状况进行比较，以了解研究结果与特定临床条目相关的程度或与更普遍的慢性疼痛相关的程度。项目1将评估青少年TMD疼痛、头痛、背痛和腹痛的患病率和发病率，并确定每一种疼痛主诉发病的危险因素。成年女性头痛和TMD疼痛的患病率远高于男性；这些研究旨在验证一种假设，即这些患病率差异始于青春期，并与青春期荷尔蒙的变化有关。项目2旨在增加对信念和应对策略影响慢性复发性疼痛患者适应的机制的科学理解。该项目将通过一项随机临床试验，评估旨在改变信念和应对策略的简短干预是否能提高接受TMD治疗的患者的结果。项目3寻求在初级保健机构对慢性复发性疼痛进行更有效和更具成本效益的综合医疗保健和自我保健。目的是确定改进的方法，用于分析TMD、背痛和头痛患者的自动化医疗保健和药物使用数据，并确定长期医疗保健使用的可改变决定因素；评估自我护理组对长期医疗保健和药物使用的影响。项目4是一项随机临床试验，旨在评估在常规TMD治疗的基础上辅以低成本的阶梯护理干预措施，教育患者自我护理，是否能改善患者的疼痛，减少寻求治疗，并随着时间的推移改善功能状态。科学核心将提供科学指导、项目协调、数据管理/统计支持和共享科学专业知识。行政管理人员将确保对计划项目的有效管理。

This application requests continuation of the Program Project TMD Longitudinal Studies: Clinical/Chronic Pain Syndromes. {{The overall goal is to conduct multi-disciplinary research aimed at understanding the onset course, and appropriate care of chronic, recurrent pain conditions, with particular emphasis on temporomandibular disorders (TMD).}} The project will continue to focus on TMD as a clinical entity, the adaptation of persons with pain to their pain problem and the interaction of pain patients with the health care delivery system. An inn integral part of the research strategy will continue to be comparison with TMD with other common chronic pain conditions, {{in order to understand the degree to which findings are related to specific clinical entries or are associated with chronic pain more generally.}} Project 1 will assess the prevalence and incidence of TMD pain, headache, back pain and abdominal pain in adolescents, and identify risk factors for onset of each of these pain complaints. The prevalence of headache and TMD pain is much higher in adult women than in men; the studies are designed to test the hypothesis that these prevalence differences begin in adolescence and are associated with the hormonal changes of puberty. Project 2 aims to increase scientific understanding of the mechanisms by which beliefs and coping strategies affect adjustment of patients with chronic, recurrent pain. The project will evaluate, through a randomized clinical trial, whether a brief intervention designed to change beliefs and coping strategies enhances outcomes of patients receiving TMD treatment. Project 3 seeks a more effective and cost-effective integrated of medical care and self-care for chronic, recurrent pain in primary care settings. The aims are identify improved methods for analysis of automated health care and medicine use data for TMD, back pain and headache patients and identify modifiable determinants lf long-term health care use; evaluate the impact of self-care groups on long term health care and medication use. Project 4 is a randomized clinical trial to evaluate whether supplementing usual TMD treatment with low cost stepped care interventions that education patients in self care improves patients' pain reduces treatment seeking and improves functional status over time A Scientific Core will provide scientific direction, project coordination, data management/statistical support and shared scientific expertise. An Administrative ore will insure effective administration on the Program Project.