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）：颞下颌肌肉和关节疼痛 (TMJD) 是第二常见的肌肉骨骼疾病，影响约 3000 万美国人，估计每年造成 40 亿美元的损失。对于普通牙医来说，诊断 TMJD 患者具有挑战性，因为躯体 TMJD 疼痛诊断缺乏预后价值 - 与心理社会 TMJD 因素不同，心理社会 TMJD 因素可为治疗选择和结果预测提供信息。然而，普通牙医并不经常使用（如果有的话）对 TMJD 进行心理社会评估，而是主要依赖于 TMJD 身体检查。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科护理的分类。该应用程序的中心研究假设是，当前的身体 TMJD 疼痛评估包含未使用但有价值的“地理”TMJD 疼痛信息，该信息与 TMJD 相关的心理社会困扰密切相关。使用这些信息将产生信息更丰富的 TMJD 疼痛诊断，从而降低 TMJD 患者心理社会评估的附加价值。颞下颌关节紊乱病会影响下颌、关节和太阳穴的多个部位，但通常也伴有牙齿、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；事实上，并非所有疼痛部位对治疗结果都具有同等的重要性，疼痛部位分布越广泛，预示着不良结果。目前，即使在诊断过程中收集了这种地理疼痛信息，除了区分疼痛的颞下颌关节与肌肉位置之外，它也不会纳入诊断。本研究的目的是通过整合有关 TMJD 疼痛位置和分布的现有信息来改进现有的 TMJD 疼痛诊断，并测试这些改进的诊断在预测心理社会困扰方面是否优于现有的诊断。使用应用最广泛的 TMJD 诊断系统，TMJD 研究诊断标准，来自最近完成的多中心 RDC/TMJD 验证项目的数据（633 例 TMJD 病例，91 名对照受试者）和来自两个德国中心的 416 例病例，提供了一种具有成本效益的方法。使用应用地理信息系统 (GIS) 分析的创新方法来确定疼痛地理信息对 TMJD 诊断的贡献的机会。具体目标是：（i）使用 TMJD 疼痛位置数据的探索性数据分析来识别与新的 TMJD 疼痛诊断相对应的 TMJD 疼痛地理模式； (ii) 测试 TMJD 疼痛地理模式是否比现有的 TMJD 疼痛诊断更好地预测社会心理困扰。该应用程序具有创新性，因为它将 TMJD 概念化为一种“地理”疼痛状况，应用了地理和公共卫生领域的复杂方法。这一应用意义重大，因为新的 TMJD 疼痛诊断将为普通牙医提供一个简单的筛查工具，使用常规收集的 TMJD 疼痛地理数据来识别患有心理社会困扰的患者，并避免对不需要的患者进行心理社会评估。