Individualized Assessment and Treatment Program for TMD: Coping as a Mechanism

TMD个体化评估和治疗方案：应对机制

• 批准号: 10337268
• 负责人: MARK D. LITT
• 金额: $ 71.05万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-11 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10337268
• 关键词: Accounting; Address; Adult; Affect; Behavioral; Chronic; Cognition; Cognitive; Cognitive Therapy; Coping Behavior; Coping Skills; Data; Development; Disease; Effectiveness; Exhibits; Family; Feeling; Frequencies; Goals; Healthcare Systems; Home environment; Individual; Life Style; Light; Measurement; Measures; Mediating; Modeling; Monitor; Moods; Orofacial Pain; Outcome; Pain; Pain Disorder; Pain Measurement; Pain interference; Pain management; Patients; Persons; Procedures; Quality of life; Randomized; Records; Relaxation; Reporting; Role; Sampling; Self Efficacy; Splint Device; Temporomandibular Joint Disorders; Testing; Thinking; Time; Training; Translating; Treatment outcome; Work; base; chronic pain; chronic painful condition; chronic widespread pain; coping; depressive symptoms; design; effective therapy; experience; improved; in vivo; individualized medicine; innovation; pain patient; pain symptom; personalized approach; programs; psychosocial; recruit; skills; skills training; smartphone Application; standard care; success; treatment effect; treatment program

Temporomandibular/orofacial pain disorders (TMD) are a group of painful conditions with multiple determinants. A number of psychosocial treatments for TMD have been developed, but overall effectiveness has been limited, and the mechanisms of treatment are unknown. This proposal has two main goals: 1) to develop a highly individualized, adaptive treatment for TMD that has potential to be more effective than other psychosocial treatments; and 2) to discover the mechanisms by which psychosocial treatments work in chronic pain. Patients with TMD-related pain of at least 3 months duration (N=160) will be randomly assigned to either a Standard Conservative Treatment +Cognitive Behavioral coping skills treatment (STD+CBT), or to an Individualized Assessment and cognitive- behavioral Treatment Program (IATP) for patients with TMD pain. Treatment in IATP will be based on a very detailed functional analysis of the patient's pain experience, in context, as derived from Experience Sampling (ES). The ES procedure will be conducted via smartphone app at a rate of 4 records per day, and will be used to gather information on patients' pain, momentary cognitions, affects, and coping behaviors, for a 2-week monitoring period prior to the beginning of treatment. Therapists will use this information to develop an individual functional analysis of pain and non-pain episodes, and determine what thoughts, feelings and actions are effective for that patient at managing pain and which are not. The information will be used to help develop adaptive coping tactics in a 6-session treatment program, offering skills training tailored to specific patient needs. During-treatment ES will allow adjustment of the treatment goals and procedures, making the treatment adaptive and able to change with changing circumstances and patient needs. This experimental treatment (IATP) will be added to a standard conservative splint-based treatment for TMD pain (STD). The combination (STD+IATP) will be compared to a STD treatment supplemented with a 6 session conventional cognitive-behavioral program not based on in-vivo assessment of pain and coping. In the STD+CBT condition ES data will be collected but will not be used to inform treatment, but will control for measurement reactivity. ES data collected prior to, during, and following both treatments (out to 12 months) will allow very precise measurement of cognitions, affects, and coping skills, as they occur in patients' home environments, and how they change over time. Outcomes will include measures of pain, interference, and depressive symptoms. The study will be able to tailor treatment based on patient experiences measured in near- real time at pain episodes, allow for adaptation of treatment as it progresses, and measure the impact on outcomes of coping changes over the long-term. The results will shed light on active mechanisms of treatment for TMD and may have implications for the management of other chronic pain conditions.

颞下颌/口面疼痛障碍（TMD）是一组痛苦的疾病 决定因素。已经开发了许多针对TMD的社会心理治疗，但总体而言 有效性受到限制，治疗机制尚不清楚。该提议有两个 主要目标：1）为TMD开发高度个性化的自适应治疗 比其他社会心理治疗更有效； 2）发现的机制 社会心理治疗在慢性疼痛方面起作用。与TMD相关疼痛至少3个月的患者 持续时间（n = 160）将随机分配给标准保守治疗 +认知 行为应对技能治疗（STD+CBT）或个性化评估和认知 - TMD疼痛患者的行为治疗计划（IATP）。 IATP的治疗将基于 从经验中得出的对患者的疼痛经历的非常详细的功能分析 采样（ES）。 ES程序将通过智能手机应用程序以每天4个记录的速度进行， 并将用于收集有关患者疼痛，瞬时认知，影响和应对的信息 行为，在治疗开始前为期2周的监测期。治疗师会使用此 信息以开发疼痛和非pain发作的个体功能分析，并确定 哪些想法，感受和行动对那个患者控制疼痛而没有的想法有效。 该信息将用于帮助制定自适应应对策略， 提供针对特定患者需求的技能培训。治疗期间ES将允许调整 治疗目标和程序，使治疗适应性并能够随着变化而改变 情况和患者需求。该实验治疗（IATP）将添加到标准中 基于保守的TMD疼痛治疗（STD）。组合（STD+IATP）将是 与补充了6个疗程的常规认知行为相比 程序不是基于体内疼痛和应对评估的程序。在STD+CBT条件中，ES数据将 收集但不会用于告知治疗，但将控制测量反应性。 es 在两种处理（到12个月）之前，期间和之后收集的数据将非常精确 认知，影响和应对技能的测量，因为它们在患者的家庭环境中发生 以及它们如何随着时间的流逝而改变。结果将包括疼痛，干扰和抑郁的措施 症状。这项研究将能够根据接近的患者经验来量身定制治疗 在疼痛发作中实时实时，可以随着治疗的进行适应，并测量影响 长期应对变化的结果。结果将阐明 TMD的治疗方法可能对其他慢性疼痛状况的管理有影响。