Brief Focused Treatment for TMD: Mechanisms of Action

描述（由申请人提供）：TMD是一种广泛的慢性疼痛疾病。TMD的成功心理治疗已经开发出来，但这些治疗达到其效果的机制还不清楚。本项目的目标是评估可能的机制负责治疗收益在TMD治疗。将通过广告从大学牙科诊所和社区招募主诉慢性面部疼痛至少3个月的男性和女性（N=106），并随机分配至采用口内夹板加抗炎剂的标准保守治疗（STD）或标准治疗+认知行为治疗计划（STD+CBT），这将包括标准治疗，但也侧重于改变自我效能和减少灾难化。两种治疗均需要6次门诊访视。将在治疗前后测量来自疼痛应对综合模型的性格和情境变量。情境变量，包括应对反应，情绪状态，情境评价和自我效能，将被测量的经验抽样范式，每天四次使用手持计算机。这样做是为了尽量减少可能阻碍早期治疗过程研究的回顾性偏倚。因变量将是在6周治疗期结束时以及此后直至12个月随访的随访时间点测量的痛苦、疼痛和活动干扰的自我报告测量值，以及皮质醇和选定细胞因子的血浆水平。预计STD+CBT治疗将导致自我效能和灾难化等结构的可测量变化，并且与STD对照相比，这些变化将与改善的结局相关。还预计组间结果差异将与炎症介质（细胞因子水平）的变化相关。最后，有人建议，在情境治疗过程变量的变化将与细胞因子水平的变化。这些结果可能揭示TMD治疗成功的真正作用机制，如果这些机制能够被成功地识别，将对开发更有效的治疗方案具有重要意义。

DESCRIPTION (provided by applicant): TMD is a widespread chronic pain condition. Successful psychosocial treatments for TMD have been developed, but the mechanisms by which these treatments achieve their effects are not well known. The goal of this project is to evaluate the possible mechanisms responsible for treatment gains in TMD treatment. Men and women (N=106) with complaints of chronic facial pain for at least 3 months' duration will be recruited from the University Dental Clinics and from the community via advertisements and randomly assigned to either a Standard Conservative Treatment (STD) employing an intraoral splint plus anti-inflammatory agents, or to a Standard Treatment + Cognitive-Behavioral Treatment Program (STD+CBT), that will include standard treatment but also focus on changing self-efficacy and decreasing catastrophization. Both treatments will entail 6 clinic visits. Dispositional and situational variables derived from a comprehensive model of pain coping will be measured before and after treatment. The situational variables, including coping responses, mood states, situational appraisals and self-efficacy, will be measured in an experience sampling paradigm four times daily using a hand-held computer. This will be done to minimize retrospective biases that may have hampered earlier studies of treatment process. Dependent variables will be self-report measures of distress, pain, and interference with activities, as well as blood plasma levels of cortisol and selected cytokines, measured at the end of the 6-week treatment period, and at follow-up points thereafter up to a 12-month follow-up. It is expected that the STD+CBT treatment will result in measurable changes in constructs such as self-efficacy and catastrophization, and that these changes will be related to improved outcomes compared to the STD controls. It is also expected that outcome differences between groups will be associated with changes in inflammatory mediators (cytokine levels). Finally, it is suggested that changes in situational treatment process variables will be associated with changes in cytokine levels. The results may indicate the true active mechanisms of successful TMD treatment, if these mechanisms can be successfully identified it would have important implications for the development of more effective treatment programs.