AN EVALUATION AND TREATMENT STUDY OF TMD

描述：(来自申请表)过去资助项目的主要目标 是为了确定何时急性颞颌关节紊乱病的有用预测因子 (TMD)事件很可能发展为慢性问题。与伟大的 在慢性TMD患者中，经济成本和传统上较差的结果，它 已经变得越来越重要，以有效地治疗 处于急性状态，以防止这些更长期的残疾问题。结果 在过去的项目中，明确地隔离了预测慢性病的风险因素。AS 作为这些重要发现的扩展，我们现在有了一个统计算法 可以用来识别急性TMD患者谁是主要的候选 早期干预，以防止慢性化。目前提议的项目 将涉及对一大批急性TMD患者进行评估，以便 筛选出那些罹患慢性病的“高危”患者。 然后，这些高危患者将被随机分配到两组中的一组 (30例/组)：早期干预组或非干预组。 干预程序将模仿发现的最多的 在我们过去的R01赠款项目中有效-生物反馈/认知相结合 行为治疗方法。随后将进行为期一年的后续评价 以评估重要的结果，如疼痛、残疾、 复发率和卫生保健利用率。据推测，早些时候 在急性期的干预将防止慢性 残疾。此外，作为前一个赠款项目的复制 结果，非干预组患者将与 初步评估的急性TMD患者的人口学匹配队列(n=60) 谁不显示“高风险”的个人资料。据推测，“高” 风险“非干预组患者将表现出更高的疼痛和 残疾患者在一年内相对于“低风险”的患者。这些 结果将对有效的早期干预和 为这一普遍的疼痛问题节省了大量的医疗成本。 最后，本拟议项目的另一个目标是 对一种潜在的关于疼痛和疼痛相互作用的启发式理论的评价 压力最近由Mezack(1996)提出。本拟议项目将 从评估一个关键字开始评估这一理论的潜在有效性 梅尔扎克建议密切参与的生物指数(皮质醇) 压力-疼痛相互作用的过程。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.