With the great economic costs and traditionally poor outcomes among chronic temporomandibular joint and muscle disorder (TMJMD) patients, it has become important to treat patients in the acute state, in order to prevent these more chronic disability problems. This has been the goal of two past funded grant projects. Results of the initial project isolated risk factors that successfully predicted the development of chronicity, with a 91% accuracy rate. A statistical algorithm was developed which was used in the second project to screen out "high-risk" patients. These patients were then randomly assigned an early intervention or non-intervention group. One-year follow-up evaluations documented the treatment efficacy and cost effectiveness of early intervention. These results have major implications for effective early intervention and significant health-care cost savings for this prevalent pain and disability problem. For the present proposed project, we plan to implement this treatment program in order to evaluate its effectiveness in more community-based dental practices. This is in response to NIH's request for the implementation of evidence-based treatment approaches, developed in controlled clinical settings, to the "real world" of diverse practices in the community. Acute TMJMD patients will be recruited from two community clinics. Based upon our "risk" screening algorithm, high-risk patients will be randomly assigned to one of two groups (n=225/group): an early biobehavioral intervention or an attention-control group. It is hypothesized that the attention control "high-risk" patients will display more chronic TMJMD problems, relative to the "high-risk" early intervention patients, at one-year follow-up. Another aim of the project is to evaluate the potential utility of new technologies that will lead to even greater precision in detecting individual differences among TMJMD patients. Measures evaluated include chewing performance, cortisol levels, and other biopsychosocial outcomes. This represents the next step in comprehensively understanding brain-behavior patterns in TMJMD. Also, structural equation modeling methodology will be used. Such a multi-level, multi-systems approach has not been applied to better understand the biopsychosocial underpinnings of TMJMD. Results from this component of the project will greatly aid in stimulating future research leading to the better understanding of TMJMD, as well as better tailoring of prescribed treatment regimens.

Public Health Relevance

Temporomandibular joint and muscle disorder (TMJMD) is a highly prevalent and costly public health problem in the United States, especially when it becomes chronic in nature. This study will further evaluate the treatment- and cost-effectiveness of an early biobehavioral intervention program for preventing chronic TMJMD. Moreover, this evidence-based program will be implemented in actual community-based dental practices to make it more accessible to the general population.

Agency
National Institute of Health (NIH)
Institute
National Institute of Dental & Craniofacial Research (NIDCR)
Type
Research Project--Cooperative Agreements (U01)
Project #
3U01DE010713-16S2
Application #
8708351
Study Section
Special Emphasis Panel (ZDE1-JH (20))
Program Officer
Clark, David
Project Start
1994-06-01
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2014-07-31
Support Year
16
Fiscal Year
2013
Total Cost
$43,394
Indirect Cost
$6,669
Name
University of Texas Arlington
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
064234610
City
Arlington
State
TX
Country
United States
Zip Code
76019
Neblett, Randy; Brede, Emily; Mayer, Tom G et al. (2013) What is the best surface EMG measure of lumbar flexion-relaxation for distinguishing chronic low back pain patients from pain-free controls? Clin J Pain 29:334-40
Neblett, Randy; Cohen, Howard; Choi, YunHee et al. (2013) The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample. J Pain 14:438-45
Lorduy, Kara M; Liegey-Dougall, Angela; Haggard, Robbie et al. (2013) The prevalence of comorbid symptoms of central sensitization syndrome among three different groups of temporomandibular disorder patients. Pain Pract 13:604-13
Dougall, Angela Liegey; Jimenez, Carmen A; Haggard, Robbie A et al. (2012) Biopsychosocial factors associated with the subcategories of acute temporomandibular joint disorders. J Orofac Pain 26:7-16
Proctor, Timothy J; Mayer, Tom G; Gatchel, Robert J et al. (2004) Unremitting health-care-utilization outcomes of tertiary rehabilitation of patients with chronic musculoskeletal disorders. J Bone Joint Surg Am 86-A:62-9
Anagnostis, Christopher; Gatchel, Robert J; Mayer, Tom G (2004) The pain disability questionnaire: a new psychometrically sound measure for chronic musculoskeletal disorders. Spine (Phila Pa 1976) 29:2290-302; discussion 2303