Simplifying the diagnostic process of TMJD pain for the general dentist

简化普通牙医 TMJD 疼痛的诊断过程

• 批准号: 8442599
• 负责人: Mike John
• 金额: $ 14.39万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-18 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442599
• 关键词: Accounting; Affect; American; Arthralgia; Behavioral; Caring; Clinical; Cluster Analysis; Complex; Data; Data Analyses; Dental; Dentists; Diagnosis; Diagnostic; Diagnostics Research; Disease; Distress; Earache; Geographic Information Systems; Geography; German population; Goals; Headache; Joint by Site; Lead; Location; Measures; Methods; Modeling; Muscle; Musculoskeletal; Myopathy; Neck Pain; Outcome; Pain; Pain Measurement; Patients; Pattern; Population; Private Practice; Process; Prognostic Marker; Psychosocial Assessment and Care; Psychosocial Factor; Public Health; Regression Analysis; Research; Scheme; Selection for Treatments; Site; Surrogate Markers; Systems Analysis; Techniques; Temporomandibular Joint; Temporomandibular Joint Disorders; Testing; Training; Treatment outcome; Triage; Validation; Work; arthropathies; base; chronic pain; cost; cost effective; improved; innovation; medical specialties; oral pain; prognostic; psychologic; psychosocial; public health relevance; screening; systems research; tool

DESCRIPTION (provided by applicant): Painful temporomandibular muscle and joint disorders (TMJD) are the second most common musculoskeletal condition, affecting approximately 30 million Americans with an estimated annual cost of $4 billion. For the general dentist, diagnosing TMJD patients is challenging because the physical TMJD pain diagnoses lack prognostic value - unlike psychosocial TMJD factors, which are informative for treatment selection and as outcome predictors. However, the psychosocial assessment for TMJD is not routinely, if ever, used by the general dentist, who instead relies primarily on physical TMJD examination. Therefore, TMJD pain diagnoses need to have better clinical utility to improve the general dentist's triaging of more complex patients for specialty care. The central research hypothesis of this application is that the current physical TMJD pain assessment contains unused but valuable "geographic" TMJD pain information that correlates well with the psychosocial distress associated with TMJD. Using this information would produce a more informative TMJD pain diagnosis and consequently reduce the additional value of psychosocial assessment of TMJD patients. TMJD affect several locations in the jaw, joint, and temple, but often dental, oral, ear, neck, and head pains are also associated. Accordingly, TMJD pain has a location and distribution component; in fact, not all pain sites have equal importance for treatment outcomes, and a wider distribution of pain sites predicts unfavorable outcomes. Currently, even if this geographic pain information is collected during the diagnostic process, it is not incorporated into the diagnosis except for distinguishing between the TMJ versus muscle location of the pain. This study's objective is to improve existing TMJD pain diagnoses by integrating available information about the location and distribution of TMJD pain and testing whether these improved diagnoses are superior to existing ones in predicting psychosocial distress. Using the most widely applied TMJD diagnostic system, the Research Diagnostic Criteria for TMJD, data from the recently completed multi-center RDC/TMJD Validation Project (633 TMJD cases, 91 control subjects) and 416 cases from two German centers provide a cost- effective opportunity for determining the contribution of pain geography information for TMJD diagnosis using an innovative methodological approach applying geographic information systems (GIS) analyses. The specific aims are: (i) to identify patterns of TMJD pain geography corresponding to new TMJD pain diagnoses using exploratory data analysis of TMJD pain location data; and (ii) to test whether patterns of TMJD pain geography predict measures of psychosocial distress better than existing TMJD pain diagnoses. This application is innovative because it conceptualizes TMJD as a "geographic" pain condition, applying sophisticated methods from geography and public health. This application is significant because the new TMJD pain diagnoses will provide general dentists with a simple screening tool using routinely collected TMJD pain geography data to identify patients with psychosocial distress and to avoid psychosocial assessment for those who do not need it.

描述（由申请人提供）：痛苦的颞下颌肌肉和关节疾病（TMJD）是第二常见的肌肉骨骼状况，影响了约3000万美国人，估计每年成本为40亿美元。对于普通牙医而言，诊断TMJD患者具有挑战性，因为物理TMJD疼痛诊断缺乏预后价值 - 与社会心理TMJD因素不同，这对于治疗选择和结果预测指标都是有益的。但是，TMJD的社会心理评估并不是普通牙医通常使用的，而普通牙医则主要依靠物理TMJD检查。因此，TMJD疼痛诊断需要具有更好的临床实用性，以改善普通牙医对更复杂的患者进行专业护理的分类。该应用的中心研究假设是，当前的物理TMJD疼痛评估包含未使用但有价值的“地理” TMJD疼痛信息，这些信息与与TMJD相关的社会心理困扰非常相关。使用此信息将产生更有信息的TMJD疼痛诊断，因此减少了TMJD患者的社会心理评估的额外价值。 TMJD会影响下颌，关节和寺庙中的几个位置，但通常也关联了牙齿，口腔，耳朵，颈部和头部疼痛。因此，TMJD疼痛具有位置和分布成分。实际上，并非所有疼痛部位对于治疗结果都具有同等的重要性，并且疼痛部位的更广泛分布预测不利的结果。目前，即使在诊断过程中收集了此地理疼痛信息，除了区分TMJ与疼痛的肌肉位置外，它也没有纳入诊断。这项研究的目标是通过整合有关TMJD疼痛的位置和分布的可用信息，并测试这些改进的诊断是否优于现有的TMJD疼痛诊断。 Using the most widely applied TMJD diagnostic system, the Research Diagnostic Criteria for TMJD, data from the recently completed multi-center RDC/TMJD Validation Project (633 TMJD cases, 91 control subjects) and 416 cases from two German centers provide a cost- effective opportunity for determining the contribution of pain geography information for TMJD diagnosis using an innovative methodological approach applying geographic information systems （GIS）分析。具体目的是：（i）使用TMJD疼痛位置数据的探索性数据分析来确定与新的TMJD疼痛诊断相对应的TMJD疼痛地理模式； （ii）测试TMJD止痛地理模式是否比现有的TMJD疼痛诊断更好地预测了心理困扰的度量。该应用具有创新性，因为它将TMJD概念化为“地理”疼痛状况，应用了地理和公共卫生的复杂方法。该应用很重要，因为新的TMJD疼痛诊断将使用常规收集的TMJD疼痛地理数据为普通牙医提供一个简单的筛查工具，以识别患有社会心理困扰的患者，并避免对不需要的人进行社会心理评估。