Mechanisms of myofascial TMD pain: endogenous pain modulation and beyond

肌筋膜 TMD 疼痛的机制：内源性疼痛调节及其他

• 批准号: 9982990
• 负责人: Vivian Santiago
• 金额: $ 15.38万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9982990
• 关键词: Address; Affect; American; Animal Experimentation; Applications Grants; Area; Arthralgia; Award; Characteristics; Classification; Clinical Research; Communities; Control Groups; Data Analyses; Data Set; Dental; Development; Disease; Epidemiologist; Esthesia; Failure; Frequencies; Functional disorder; Heterogeneity; Human; Human Subject Research; Iatrogenesis; Individual; Joints; Laboratories; Left; Maintenance; Masticatory muscles; Measures; Mentored Research Scientist Development Award; Mentorship; Methods; Muscle; Musculoskeletal Pain; Myofascial Pain Syndromes; Nature; Nervous System Physiology; Neuraxis; Neurobiology; Neurosciences; Nociception; Oral; Pain; Pain Research; Pain management; Pathology; Patients; Pattern; Peripheral; Phase; Phenotype; Preparation; Psychophysics; Public Health; Research; Research Personnel; Research Training; Role; Sampling; Science; Self Management; Sensory; Sleep; Source; Stimulus; Syndrome; System; Taxonomy; Temporomandibular Joint; Temporomandibular Joint Disorders; Test Result; Testing; Time; Training; Translational Research; Woman; base; case control; central pain; chronic pain; chronic painful condition; comorbidity; conditioned pain modulation; cost; craniofacial; design; dual diagnosis; experience; human subject; improved; innovation; interest; meetings; opioid epidemic; pain patient; response; stem; theories

PROJECT SUMMARY/ABSTRACT Most Americans experience some form of musculoskeletal pain in their lifetime and painful myofascial Temporomandibular Disorder (mTMD) is one condition affecting at least 10% of community women. The causes of mTMD are poorly understood. Patients are often left with expensive or invasive treatments for which evidence of efficacy is mixed at best. Persistent mTMD is increasingly considered a chronic pain condition, with a presumed dysfunction in a central pain mechanisms such as in endogenous pain modulation. Despite increasing research, including use of quantitative sensory testing, conclusive evidence of pathology has not emerged. Given the complexity of human neurobiology, including the inherently dynamic and stimulus- dependent nature of endogenous pain modulation, lack of progress may be due to unmeasured confounding. This proposal will use an innovative approach to address potential confounding introduced by phenotypic heterogeneity and nociceptive burden. First, phenotypes of mTMD based on presence of joint pain, i.e. muscle only-based pain (M-pain) versus both muscle and joint-based pain (MJ-pain) will be refined to determine case groups. Second, unmeasured nociceptive input from other potential sources, (i.e., nociceptive burden) will be addressed by examining both comorbidities that represent peripheral sensitization and laboratory-based sleep masticatory muscle activity. To conduct a more valid examination of the role of endogenous pain modulation dysfunction in mTMD, the following aims will be examined first in a completed case-control dataset of women, and second in planned pilot research: (1) Explore characteristics of temporomandibular joint pain to classify mTMD patients as M-pain or MJ-pain and examine patterns of comorbid disorders; (2) Compare facilitatory pain modulation among the M-pain, MJ-pain and control groups; and (3) Compare inhibitory pain modulation among M-pain, MJ-pain and control groups. To accomplish the proposed research and develop a research agenda that can uncover mechanisms of mTMD, the present application for a Mentored Research Scientist Development Award to Promote Diversity in Dental, Oral and Craniofacial Research Workforce (K01) proposes to advance the expertise of a trained psychiatric epidemiologist in four areas: (1) chronic pain taxonomy (clinical and research); (2) neuroscience of pain and translational research; (3) psychophysics of pain; and secondarily (4) systems science approaches for the study of chronic pain. The proposed research and training will result in submission of an R01 grant proposal on mechanisms of myofascial pain onset and maintenance in human subjects.

项目摘要/摘要 大多数美国人一生都经历了某种形式的肌肉骨骼疼痛和痛苦的肌筋膜 颞下颌疾病（MTMD）是影响至少10％社区妇女的疾病。这 MTMD的原因知之甚少。患者通常会接受昂贵或侵入性的治疗 功效的证据充其量是混合的。持续的mtmd越来越被认为是慢性疼痛状况， 在中央疼痛机制（例如内源性疼痛调节中）中假定功能障碍。尽管 越来越多的研究，包括使用定量感觉测试，病理学的结论性证据尚未 出现了。鉴于人类神经生物学的复杂性，包括固有的动态和刺激 内源性疼痛调节的依赖性，缺乏进展可能是由于无法衡量的混杂。 该提案将使用一种创新的方法来解决表型引入的潜在混杂 异质性和伤害负担。首先，基于关节疼痛的MTMD表型，即肌肉 只有基于基于肌肉和肌肉和联合疼痛（MJ-Pain）的疼痛（M-Pain）才能确定案例 组。其次，来自其他潜在来源的未衡量的伤害感染输入（即伤害性负担）将是 通过检查代表外围敏化和基于实验室睡眠的合并症来解决 咀嚼性肌肉活性。对内源性疼痛调节的作用进行更有效的检查 MTMD的功能障碍，将首先在完整的病例控制妇女数据集中检查以下目标， 在计划的试点研究中第二：（1）探索颞下颌关节痛的特征以对 MTMD患者为M-Pain或MJ-Pain，并检查合并症的模式； （2）比较促进性 M-Pain，MJ-Pain和对照组之间的疼痛调节； （3）比较抑制性疼痛调节 在M-Pain，MJ-Pain和对照组中。完成拟议的研究并开发研究 可以揭示MTMD机制的议程，这是当前的指导研究科学家的申请 开发奖旨在促进牙科，口腔和颅面研究人员（K01）的多样性提议 提高四个领域训练有素的精神病学家的专业知识：（1）慢性疼痛分类法 （临床和研究）； （2）疼痛和转化研究的神经科学； （3）疼痛的心理物理学；和 其次（4）系统科学方法用于研究慢性疼痛。拟议的研究和培训 将导致关于肌筋膜疼痛发作机制的R01赠款提案 人类主题。