Hormonal Cycles in Women: Effects on Temporomandibular Disorder Pain & Symptoms

描述(申请人提供)：疼痛被定义为“一种与实际或潜在的组织损伤有关的不愉快的感觉和情感体验。”因此，疼痛不可避免地是身心相互作用的产物。我们建议研究与颞下颌关节紊乱病(TMD)相关的精神和身体的相互作用，TMD是一组涉及咀嚼肌和颞下颌关节的疼痛状况。在社区中，这些疼痛问题在女性中的常见程度大约是男性的两倍，患病率在生殖年中达到顶峰。TMD疼痛的病因尚不清楚，但心理压力、抑郁和其他躯体主诉的存在已被证明影响这些疾病的进程。先前的研究表明，女性生殖激素也可能影响TMD疼痛。具体地说，正常情况下，患有TMD的骑自行车女性在雌激素急剧下降的月经前经历TMD疼痛水平的上升，并在月经期间表现出TMD疼痛的峰值。有趣的是，TMD疼痛的第二个高峰出现在排卵时，另一个阶段对应于雌激素的快速变化。这些数据显示了TMD疼痛程度和月经周期各阶段之间的系统性关系。我们提出了两项相关的研究，以进一步研究女性TMD疼痛的周期性。研究1将评估月经周期正常的女性TMD患者(n=35)在连续两个月经周期中疼痛与唾液生殖激素水平和心理压力的关系，以及相同大小的适当对照组--正常骑自行车的有阵发性头痛的女性和没有TMD、头痛或其他慢性疼痛问题的正常骑自行车的对照组女性。研究1旨在验证这样一种假设，即临床疼痛和症状在整个月经周期中的增加与雌激素停用和感觉到的压力增加有关。研究2将操纵假设影响TMD疼痛的行为和荷尔蒙因素，比较：1)旨在抑制月经和稳定荷尔蒙环境的持续口服避孕药干预，2)关注TMD症状在整个月经周期的时间生物学的自我管理干预，以及3)不计时于生物事件的常规自我管理干预的效果。这项临床试验的目的是阐明女性TMD疼痛和症状周期性的潜在机制，并确定哪种治疗方式对TMD疼痛和症状的改善最大。因此，拟议的研究将提供关于女性痛觉的生物学和心理社会方面的关系的重要和独特的信息。

DESCRIPTION (provided by applicant): Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage." Thus, pain is, inevitably, a product of the interaction of mind and body. We propose to study the interactions of mind and body related to temporomandibular disorders (TMD), a group of painful conditions involving the muscles of mastication and the temporomandibular joint. These pain problems are about twice as common in women as in men in the community, and prevalence peaks during the reproductive years. The etiology of TMD pain is unknown, but psychological stress, depression and the presence of other somatic complaints have been shown to influence the course of these disorders. Prior research suggests that female reproductive hormones may also influence TMD pain. Specifically, normally cycling women with TMD experience rising levels of TMD pain pre-menstrually during a time of precipitous drop in estrogen and show peak TMD pain during menses. Interestingly, a secondary peak of TMD pain occurs at about the time of ovulation, another phase corresponding to rapid estrogen change. These data demonstrate a systematic relationship between levels of TMD pain and phases of the menstrual cycle. We propose two related studies to further investigate the cyclic nature of TMD pain in women. Study 1 will assess the relationship of pain to salivary levels of reproductive hormones and to psychological stress across two consecutive menstrual cycles for female TMD patients with normal menstrual cycles (n = 35), as well as appropriate comparison groups of the same size --normally cycling women with episodic headache and normally cycling control women without TMD, headache or other chronic pain problems. Study 1 is designed to test the hypothesis that increases in clinical pain and symptoms across the menstrual cycle are associated with estrogen withdrawal and increased perceived stress. Study 2 will manipulate the behavioral and hormonal factors that are hypothesized to influence TMD pain, comparing the effects of: 1) a continuous oral contraceptive intervention designed to suppress menses and stabilize the hormonal environment, 2) a self-management intervention focused on and timed to the chronobiology of TMD symptoms across the menstrual cycle, and 3) a usual self-management intervention not timed to biological events. The aims of this clinical trial are to shed light on the mechanisms underlying the cyclic nature of TMD pain and symptoms in women, as well as to determine which treatment modality results in the greatest improvement in TMD pain and symptoms. Thus, the proposed studies will provide important and unique information on the relationships of biological and psychosocial aspects of pain perception in women.