The National Institutes of Health, with PA-13-119 Mechanisms, Models, Measurement, &Management in Pain Research, have made research on pain conditions such as temporomandibular disorders (TMD) a high-priority area of research because of its high prevalence and functional limitations, missed work, and high health care cost when it becomes chronic. In 2011, the Institute of Medicine also established research involving self- management strategies as one of the highest priority topics. To support self-management, the use of consumer-based health information technology (HIT) has been proposed in many fields to train patients, but not yet in pain management. Thus, research in the fidelity, acceptability, outcomes, and sustainability of employing HIT to engage patients in self-management of pain conditions has been encouraged. The overall goal of this R34 planning grant is to design a U01 pilot clinical trial that will determine feasibility of methods and the outcomes of an innovative HIT platform to deliver self-management training for TMD pain. The pilot study will then lead to a future application for a full-scale multi-site clinical trial. Thistrial would be designed to determine the comparative effectiveness of the HIT-based self-management program to decrease pain and improve functional status and health care utilization in TMD patients in real-world settings. The self- management program, Personalized Activated Care and Training (PACT), is a tailored 10-week progressive self-management training program supported by HIT and implemented by dentists to enhance understanding, compliance, and success in self-management of TMD pain. The self-management strategies of education, exercise, and cognitive and behavioral changes have documented efficacy. In the U01 study, we will evaluate the feasibility of methods involved in the HIT-delivered intervention to enhance education, compliance, and follow up and describe preliminary program outcomes on standardized measures of symptom severity, functional status, and health care utilization. We will recruit a total of 80 patients with TMD pain into either: 1) the HIT-based intervention arm;o 2) an active control arm consisting of usual care of medication and splints as ordered by the treating dentist.
The purpose of this pilot project is to determine the feasibility of methods and estimate the preliminary efficacy of a tailored self-management program to decrease pain and prevent chronic pain in patients with temporomandibular disorders compared with usual care. This program is designed to educate and engage patients in a 10-week personalized program of exercise and behavioral changes implemented through health information technology.