Mechanistic Characterization of Pain in Temporomandibular Disorders: Does Pain Centralization Influence Responsiveness to Peripherally Targeted Treatments?

颞下颌疾病疼痛的机制特征：疼痛集中化是否会影响外周靶向治疗的反应？

• 批准号: 10213007
• 负责人: Daniel Elliott Harper
• 金额: $ 24.62万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-08 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10213007
• 关键词: Address; Affect; American; Area; Award; Brain; Brain imaging; Brain region; Characteristics; Cheek structure; Chemistry; Chronic; Clinic; Coupled; Data; Diagnosis; Disease; Equipment; Etiology; Exhibits; Face; Faculty; Failure; Fatigue; Fibromyalgia; Functional Magnetic Resonance Imaging; Functional disorder; Future; Goals; High Prevalence; Individual; Individual Differences; Inflammation; Injury; Insula of Reil; Jaw; Knowledge; Label; Laboratories; Lead; Learning; Light; Literature; Location; Machine Learning; Magnetic Resonance Imaging; Measures; Mentors; Mentorship; Michigan; Motor Cortex; Naproxen; Neurotransmitters; Nociception; Non-Steroidal Anti-Inflammatory Agents; Orofacial Pain; Pain; Pain Research; Paper; Pathology; Patients; Peripheral; Peripheral Nervous System; Persistent pain; Phase; Phenotype; Positioning Attribute; Precision Medicine Initiative; Process; Prognosis; Psychometrics; Public Health; Publishing; Quality of life; Questionnaires; Reporting; Research; Research Personnel; Research Project Grants; Resources; Running; Sample Size; Sensory; Series; Soft Diet; Somatosensory Cortex; Stimulus; Structure; TMD treatment; Techniques; Temporomandibular Joint Disorders; Temporomandibular joint disorder pain; Testing; Training; Treatment Protocols; Treatment outcome; United States National Institutes of Health; Universities; Woman; base; brain abnormalities; brain morphology; central pain; chronic pain; chronic painful condition; chronic pelvic pain; clinical pain; clinically relevant; dietary restriction; follow-up; gray matter; improved; individualized medicine; innovation; neurochemistry; neuroimaging; pain processing; personalized medicine; programs; relating to nervous system; response; skills; targeted treatment; tenure track

Project Summary / Abstract Temporomandibular disorders (TMD), characterized by persistent pain in the cheek and jaw area of the face, affect approximately 1 in 10 women at some point in their lives. TMD treatments primarily focus on peripheral factors; however, many patients with TMD show no signs of peripheral damage. It is now known that many chronic pain conditions, including TMD, involve pain centralization, meaning the pain is generated and maintained by central, rather than peripheral, nervous system processes. There are currently no well accepted means through which centralized TMD pain can be identified in the clinic, and the failure to properly identify these centralized cases means that ineffective peripheral treatments are administered. The specific aims of this project are to 1) Demonstrate that structural, functional, and neurochemical abnormalities exist in TMD that are similar to those reported in other centralized pain conditions, 2) Utilize questionnaire and quantitative sensory testing measures that can accurately detect centralized pain to place patients on a continuum from peripheral to centralized, and show that the brains of centralized, but not peripheral, patients differ significantly from healthy controls, and 3) Determine the measures of centralization and brain morphology, function, and chemistry that predict lack of improvement from a peripherally targeted treatment regimen, to show that centralized TMD patients do not respond as well to treatments that fail to target their pathology. The primary goal of the mentored (K99) portion of the award is to give the candidate the additional training in neuroimaging necessary for him to obtain a tenure track faculty position and successfully run his own independent research program. The K99 phase will take place at the University of Michigan, under the mentorship of Drs. Daniel Clauw, Richard Harris, and David Williams, who are world-renowned experts in centralized pain conditions, pain neuroimaging, and pain psychometrics, respectively. Dr. William Maixner (Duke University), a world- leading expert on TMD, will also serve as a mentor; he will advise the candidate on the clinically relevant aspects of TMD and help the candidate network with other more established TMD researchers. The University of Michigan is ideal for the K99 phase of the project because of the available resources, including faculty who are committed to clinical pain research and mentoring, research-devoted magnetic resonance imaging (MRI) scanners and state-of-the-art pain testing equipment, and ample laboratory and office space at the Chronic Pain and Fatigue Research Center. Upon completing the K99 portion of the award, the candidate will be well suited to make the transition to tenure-track faculty.

项目摘要 /摘要 颞下颌疾病（TMD），其特征是脸颊和下颌区域持续疼痛， 在生活中的某个时刻影响十分之一的女性。 TMD治疗主要关注周围 因素；但是，许多TMD患者没有外周损伤的迹象。现在知道很多 包括TMD在内的慢性疼痛状况涉及疼痛集中术，这意味着疼痛是产生的，并且 由中央而不是周围神经系统过程维护。目前没有被接受的 在诊所中可以识别出集中式TMD疼痛的手段，以及未能正确识别的方法 这些集中案件意味着对无效的外围治疗进行施用。具体目的 该项目是1）证明TMD中存在结构，功能和神经化学异常 与其他集中式疼痛条件中报道的相似，2）使用问卷调查和定量 感官测试措施可以准确地检测到集中疼痛以使患者从 集中式的外围，并表明集中式但没有外围的大脑显着差异 从健康控制中，3）确定集中化和脑形态，功能和 预测外围靶向治疗方案缺乏改善的化学反应，以表明 集中式TMD患者对未能针对其病理的治疗方法没有反应。主要 该奖项的指导者（K99）的目标是为候选人提供额外的神经影像学培训 他需要获得任期教师的职位并成功地进行自己的独立研究所需的必要 程序。在DRS的指导下，K99阶段将在密歇根大学举行。丹尼尔 Clauw，Richard Harris和David Williams是全球著名的痛苦条件专家， 疼痛神经影像学和疼痛精神计量学分别。 William Maixner博士（杜克大学），世界 - TMD领先的专家也将担任导师。他将向候选人提供有关临床相关的候选人 TMD的各个方面，并帮助候选人网络与其他更既定的TMD研究人员。大学 密歇根州的of Michigan非常适合该项目的K99阶段，因为可用资源，包括教师 致力于临床疼痛研究和指导，研究介绍的磁共振成像（MRI） 扫描仪和最先进的疼痛测试设备，以及慢性的足够的实验室和办公空间 疼痛和疲劳研究中心。完成该奖项的K99部分后，候选人将很好 适合过渡到终身教师的过渡。