Pain in adolescents: biologic/psychosocial risk factors

我们提出了一个为期五年的研究计划，旨在评估青少年中颞下颌关节紊乱病(TMD)疼痛、头痛、背痛和腹痛的患病率和发生率，并确定这些常见疼痛的发病危险因素{{症状}}。由于成年女性头痛和TMD疼痛的患病率比成年男性高得多，这些研究旨在检验全球假说，即这种患病率差异始于青春期，并与青春期的荷尔蒙变化有关。研究1的具体目标是：1)在电话调查中，从确定的人群中随机抽取11-17岁(最终n=2970)的青少年，评估TMD疼痛、头痛、背痛和腹痛的患病率、严重程度和时间特征；2)确定这四个地点每个地点疼痛的潜在危险因素；3)对所有报告TMD疼痛的受访者以及那些没有TMD疼痛的受访者进行标准化检查和访谈(预期n=130%报告TMD疼痛的受访者，以及不报告TMD疼痛的样本(预期n=130个同龄人组)，以便：a)比较病例和对照组中TMD的临床体征和症状的比率，以及b)使用标准化检查方法和诊断算法估计特定临床亚型TMD(肌筋膜痛、椎间盘移位、关节痛、关节炎/关节)的患病率。考试将在受试者家中进行，由注册牙科卫生员进行培训，并进行可靠性校准。研究2的具体目标是：1)对研究1(n=1902)的11岁受访者进行为期3年的跟踪调查，使用简短的邮寄调查和更广泛的18个月和3年的跟踪数据收集。监测TMD疼痛、头痛、背痛和腹痛的发病率。评估这些疼痛问题对活动的干扰、药物的使用和对疼痛的卫生保健使用率的影响；2)确定引起{{TMD疼痛，头痛，背部和腹部疼痛}}和GT的危险因素；所有疼痛的假定危险因素包括：女性，现有疼痛主诉和其他躯体症状的数量，前一年的医疗保健次数，以及心理困扰；此外，我们假设性成熟是TMD疼痛和头痛发生的危险因素；3)估计每个疼痛患者在3年随访期内的抵消率和复发率；以及，4)使用研究1所述的检查方法和诊断算法，对TMD疼痛的发病病例进行检查，以估计特定亚型TMD的患病率。

We propose a five-year program of research aimed at assessing the prevalence and incidence of temporomandibular disorder (TMD) pain, headache, back pain, and abdominal pain in adolescents., and identifying risk factors for onset of each of these common pain {{symptoms}}. Because the prevalence of headache and TMD pain is much higher in adult women than in adult men, the studies are designed to test the global hypothesis that this prevalence differences begin in adolescence and are associated with the hormonal change of puberty. The specific aims of study 1 are: 1) In a telephone survey, assess the prevalence, severity and temporal characteristics of TMD pain, headache, backpain and abdominal pain in an age- and sex-stratified random sample of adolescents, ages 11- 17 (final n= 2970) from a defined population; 2) Identify potential risk factors for pain at each of these four sites; 3) Conduct standardized examinations and interviews for all respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 per respondents reporting TMD pain, as well as a sample of those without TMD pain (expected n's = 130 peer group) in order to: a) compare the rates of clinical signs and symptoms of temporomandibular disorders in cases and controls, and b) estimate the prevalence of specific clinical subtypes of TMD (myofascial pain, disc displacements, arthralgia, arthritis/arthrosis) using standardized examination methods and diagnostic algorithms. Examinations will be conducted in subjects' homes by Registered Dental Hygienists training and calibrated for reliability. The specific aims of Study 2 are: 1) Follow the cohort of 11 year old respondents from Study 1 (n= 1902) over a 3-year follow up period, using brief mail-in surveys and more extensive follow up data collection at 18 months and 3 years. Monitor rates of onset of TMD pain, headache, back pain and abdominal pain. Assess the impact of these pain problems in terms of interference with activities, use of medications and rates of health care use for pain; 2) Identify risk factors for onset of {{TMD pain, headache, back and abdominal pain}}> Hypothesized risk factors for all pains include: female gender, number of existing pain complaints, and other somatic symptoms, numbers of health care visits in the prior year, and psychological distress; in addition, we hypothesize that sexual maturity is a risk factor for onset of TMD pain and headache; 3) Estimate rates of offset and recurrence of each of the pain c9ompliants over the 3-year follow up period; and, 4) Conduct examinations of the incidence cases of TMD pain, using examination methods and diagnostic algorithms as described for Study 1, to estimate the prevalence of specific subtypes of TMD.