This is a request for a competitive renewal of an NIMH Independent Scientist Award (K02). It will provide important continuity of my research program developed during an original K02 award (1993-98). The proposal presents 3 separate research projects that evaluate an early prediction-intervention approach to 2 costly chronic pain syndromes-low back pain (LBP) and temporomandibular disorder (TMD). Early detection to prevent such chronic disorders is now recognized as a high priority research area in the PHS Report of """"""""Healthy People 2000."""""""" The goal of the first project is the assessment of a large cohort of acute LBP patients in order to screen out those patients who are at """"""""high risk"""""""" for developing chronic disability. This screening will be accomplished by using a statistical algorithm developed in an earlier RO1 project that successfully identified such """"""""high risk"""""""" patients. These """"""""high risk"""""""" patients will then be randomly assigned to an early intervention or a nonintervention group. One-year follow-up evaluations will assess important socioeconomic outcomes such as return to work and health- care utilization rates. The second project parallels the earlier conducted study that successfully identified """"""""high risk"""""""" acute LBP patients. This project will develop a specific algorithm for predicting the development of chronic TMD. Those acute patients who subsequently develop chronic problems will then participate in a second phase which evaluates the relative efficacy of 4 techniques, 3 of which are biobehovioral approaches. Finally, the third project will also assess an early assessment intervention model with TMD. It will parallel the methodology used in the first project. """"""""High risk"""""""" patients, screened on the basis of a statistical algorithm, will be randomly assigned to either early intervention or nonintervention. Long term follow-up of these patients will assess important diagnostic, self-report and functional changes. Finally, interwoven within all 3 projects will be the evaluation of a potentially heuristic theory of the interaction between pain and stress. We are now at a point to identify early signs of chronicity, and then provide early intervention in order to prevent costly problems from developing. These 3 research projects will explore the efficacy of early identification of """"""""high risk"""""""" acute patients in order to provide biobehavioral treatment intervention, while simultaneously evaluating cost-effectiveness.
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