TMD

基本信息

批准号：
7719108
负责人：
MARK D. LITT
金额：
$ 2.79万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-04-01 至 2009-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7719108
关键词：
Accounting Address Behavior Behavior Therapy Behavioral Cells Cellular Immunity Class Cognition Cognitive Combined Modality Therapy Computer Retrieval of Information on Scientific Projects Database Condition Coping Behavior Daily Development Disease Exhibits Feeling Frequencies Funding Goals Grant HPSE gene Hydrocortisone Inflammatory Institution Measures Mediating Monitor Moods Numbers Outcome Pain Pain management Patients Perception Physiological Plasma Play Predictive Factor Process Research Research Personnel Resources Role Sampling Self Efficacy Source Specific qualifier value Standards of Weights and Measures Stress Temporomandibular Joint Dysfunction Syndrome Thinking Time Treatment outcome United States National Institutes of Health base behavior change chronic widespread pain coping cytokine experience follow-up hypothalamic-pituitary-adrenal axis improved pain adaptation programs psychosocial response splint therapy therapy design treatment effect treatment program

项目摘要

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Temporomandibular joint dysfunction (TMD)is a widespread chronic pain condition. A number of psychosocial treatments for TMD have been developed that have been successful for a majority of patients. The mechanisms by which these treatments achieve their effects, however, are not well specified. The general goal of the current study is to evaluate the cognitive, behavioral, and physiological mechanisms of treatment to discover what accounts for treatment gains in this disorder. To do this we will deliver to patients a brief cognitive-behavioral treatment designed to maximize adaptive cognitions and behaviors, while periodically monitoring their pain, thoughts, feelings, and coping behaviors using an experience sampling paradigm. Specifically the aims are as follows: 1. To evaluate the effects on TMD patients' pain and psychosocial functioning of a brief treatment that combines a standard splint therapy with a focused cognitive-behavioral program (STD+CBT) intended to maximize coping self-efficacy and minimize catastrophization in response to specific pain-related circumstances. H1. It is hypothesized that patients exposed to the brief cognitive behavior treatment will have better outcomes than will a group of patients given a standard conservative treatment based on splint therapy without cognitive-behavioral treatment. 2. To determine what situational factors and dispositional factors are predictive of general adaptation and pain perception following TMD treatment. H2. It is expected that both dispositional factors, and situational factors measured four times daily, will play a role in predicting adaptation and pain following treatment. 3. To determine specifically what moods, cognitions and coping behaviors are changed as a result of treatment. H3. It is predicted that patients in the STD+CBT treatment will exhibit increased numbers of specific coping behaviors, improved mood, higher self-efficacy for pain control, and decreased frequency and intensity of catastrophization as measured in real time, as compared to STD patients, and that these changes will be associated with treatment outcome. 4. To determine what effects treatment per se may have on measures of physiological stress and cell-mediated immunity. H4. It is expected that, at the follow-up points, subjects in the STD+CBT group will have lower levels of plasma cortisol and lower levels of proinflammatory cytokines than will the STD subjects. 5. To determine whether changes in treatment-related situational process variables such as self-efficacy are associated with changes in cortisol and cytokine levels, suggesting that psychosocial treatments act partly by altering HPA axis and cell-mediated inflammatory processes. H5. It is hypothesized that changes in number of coping behaviors used and changes in situational self-efficacy and catastrophization will be correlated with changes in cortisol and cytokine levels from pre-to post-treatment. The results may indicate what classes of variables need to be addressed to enhance treatment for TMD sufferers, and start to pinpoint the true active mechanisms accounting for improvement in TMD treatment. If these mechanisms can be successfully identified it would have implications for the development of more effective treatment programs for TMD and for related disorders.

该副本是利用众多研究子项目之一由NIH/NCRR资助的中心赠款提供的资源。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构是对于中心，这不一定是调查员的机构。颞下颌关节功能障碍（TMD）是一种广泛的慢性疼痛状况。已经开发了许多针对大多数患者的TMD的社会心理治疗。然而，这些治疗实现其作用的机制尚未得到很好的指定。当前研究的一般目标是评估治疗的认知，行为和生理机制，以发现该疾病中治疗增长的原因。为此，我们将为患者提供短暂的认知行为治疗，旨在最大程度地提高自适应认知和行为，同时使用经验取样范式来定期监测他们的痛苦，思想，感觉和应对行为。具体而言，目的如下： 1。为了评估短暂治疗的TMD患者疼痛和社会心理功能的影响，该治疗将标准夹板疗法与集中的认知行为计划（STD+CBT）结合在一起，旨在最大程度地提高应对自我效能感并最大程度地减少灾难化，以响应特定疼痛的情况。 H1。假设暴露于短暂认知行为治疗的患者将获得更好的结果，这比一组患者将基于夹板治疗而没有认知行为治疗的标准保守治疗。 2。确定哪些情况因素和处置因素可以预测TMD处理后的一般适应和疼痛感知。 H2。可以预期，每天四次测量的处置因素和情况因素将在预测治疗后的适应和疼痛方面发挥作用。 3。具体确定因治疗而改变了哪些情绪，认知和应对行为。 H3。据预测，与性病患者相比，在性病+CBT治疗治疗中的患者将表现出更多的特定应对行为，改善的情绪，更高的自我效能，疼痛控制的自我效能感，降低灾难性和灾难性的频率和强度，与性病患者相比，这些变化将与治疗结果相关。 4。确定治疗本身可能对生理胁迫和细胞介导的免疫的措施有什么影响。 H4。预计，在随访点，STD+CBT组中的受试者的血浆皮质醇水平将比STD受试者较低。 5。确定与治疗相关的情境过程变量（例如自我效能感）是否与皮质醇和细胞因子水平的变化有关，这表明心理社会治疗部分通过改变HPA轴和细胞介导的炎症过程来起作用。 H5。假设所使用的应对行为数量的变化以及情境自我效能和灾难性的变化将与治疗前的皮质醇和细胞因子水平的变化有关。结果可能表明需要解决哪些类别的变量以增强TMD患者的治疗，并开始查明真正的主动机制，以改善TMD治疗。如果可以成功识别这些机制，它将对开发TMD和相关疾病的更有效治疗计划产生影响。