The Minnesota TMD IMPACT Collaborative: Integrating Basic/Clinical Research Efforts and Training to Improve Clinical Care

总结 颞下颌关节紊乱病（TMD）是一个涵盖性术语，包括功能障碍和疼痛， 颞下颌关节（TMJ）以及咀嚼肌。TMD是第二常见的 慢性腰痛后的慢性肌肉骨骼疾病，影响约10至15%的成人， 4%至7%的青少年。TMD的病因被认为是多因素的，有几个危险因素似乎 在TMD期间易患、加重或延长疼痛，包括生物因素（例如，性激素）， 内源性阿片功能，解剖基因型差异，创伤，口腔功能异常， 心理社会因素（例如，压力暴露、疼痛应对、压力、灾难化）。启动的机制 并在TMD期间促进疼痛尚未确定。TMD疼痛可以严重影响个人的日常生活 活动，造成心理社会功能障碍和生活质量恶化，因此，重要的是要制定手段， 以便及早发现并为患者提供有效的治疗。该建议旨在建立一个 协作组的总体目标是提高TMD疼痛患者的诊治水平。到 为了实现这一目标，一个合作团队将致力于创建一个多学科的计划，包括临床 基础研究人员、牙医、医生和患者倡导者关注以下四个支柱： 临床护理、研究、教育和消费者参与。明尼苏达州的几个重点领域 与NIH倡议合作，TMD协作改善以患者为中心的翻译 研究（TMD IMPACT）。为了定位这种合作，以实现这四个支柱，病人登记 将建立收集和分析数据的临床和基础研究，以提高 TMD患者疼痛的诊断和治疗。四个具体目标旨在支持合作 初始阶段的工作：将建立患者招募和试点数据收集的基础设施 (Aim 1）;将为TMD适应性试验开发和实施全面的患者数据库 (Aim 2）;将建立生物库和生物标志物分析管道（目标3）;并计划将联合收割机研究 将发展有关战区导弹防御系统的专门培训（目标4）。本建议的总体目标是 建立和培养包括临床医生和基础研究人员在内的主要研究者的协作 共同的目标是通过患者的诊断和治疗来改善TMD疼痛患者的诊断和治疗， 登记处将收集数据，并为临床、转化和基础研究的分析做好准备。

SUMMARY Temporomandibular disorders (TMD) is an umbrella term that includes dysfunction and pain involving the temporomandibular joint (TMJ) as well as the masticatory muscles. TMD is the second most common chronic musculoskeletal condition after chronic low back pain, affecting approximately 10 to 15% for adults and 4% to 7% for adolescents. The etiology of TMD is considered multifactorial, and several risk factors appear to predispose, precipitate, or prolong pain during TMD, including biological factors (e.g., sex hormones), endogenous opioid function, differences in anatomical genotypes, trauma, oral parafunctions, and psychosocial factors (e.g., stress exposure, pain coping, stress, catastrophizing). The mechanisms that initiate and promote pain during TMD have not been determined. TMD pain can severely affect the individual’s daily activities, causing psychosocial dysfunction and worsening quality of life, thus it is important to develop means for early detection and provide effective treatments for those afflicted. This proposal aims to establish a collaborative group with an overall goal to improve the diagnosis and treatment of TMD patients with pain. To accomplish this goal, a collaborative team will work to create a multidisciplinary program composed of clinical and basic researchers, dentists, physicians, and patient advocates focused on the following four pillars: clinical care, research, education, and consumer engagement. Several of the focus areas for the Minnesota Collaborative align with the NIH initiative, TMD Collaborative for Improving Patient-Centered Translational Research (TMD IMPACT). In order to position this collaborative to achieve these four pillars, a patient registry will be established to collect and make data ready for analysis for clinical and basic research to improve the diagnosis and treatment of pain in TMD patients. Four specific aims were designed to support the collaborative effort in the initial phase: an infrastructure for patient enrollment and pilot data collection will be established (Aim 1); a comprehensive patient database for the adaptive trial on TMD will be developed and implemented (Aim 2); a biobank and biomarker analysis pipeline will be established (Aim 3); and a plan to combine research training with specialty training in TMD will be developed (Aim 4). The overall objective of this proposal is to establish and nurture a collaborative of principal investigators that includes clinicians and basic researchers with the common goal to improve the diagnosis and treatment of TMD pain patients by the means of a patient registry which will collect data and make it ready for analysis for clinical, translational, and basic research.