(from the application) A major goal of a past funded grant project was to identify useful predictors of when acute temporomandibular disorder (TMD) incidents were likely to develop into chronic problems. With the great economic cost and traditionally poor outcomes among chronic TMD patients, it has become increasingly more important to effectively treat patients in the acute state in order to prevent these more chronic disability problems. Results of this past project clearly isolated risk factors that predict chronicity. As an extension of these important findings, we now have a statistical algorithm that can be used to identify acute TMD patients who are prime candidates for early intervention in order to prevent chronicity. The present proposed project will involve the assessment of a large cohort of acute TMD patients in order to screen out those patients who are at """"""""high risk"""""""" for developing chronicity. These high-risk patients will then be randomly assigned to one of two groups (30 patients/group): an early intervention group or a non-intervention group. The intervention procedure will be modeled after that found to be most effective in our past R01 grant project - a combined biofeedback/cognitive behavioral treatment approach. One-year follow-up evaluations will subsequently be conducted in order to assess important outcomes such as pain, disability, relapse, and health-care utilization rates. It is hypothesized that early intervention at the acute stage will prevent the development of chronic disability. In addition, as a replication of the previous grant project results, the non-intervention group patients will be compared to a demographically matched cohort (n=60) of initially assessed acute TMD patients who do not display the """"""""high risk"""""""" profile. It is hypothesized that the """"""""high risk"""""""" non-intervention group patients will demonstrate higher rates of pain and disability at one year relative to the """"""""low risk"""""""" profile patients. These results will have major implications for effective early intervention and result in significant health-care cost savings for this prevalent pain problem. Finally, an additional goal of this present proposed project will be the evaluation of a potentially heuristic theory of the interaction of pain and stress recently proposed by Mezack (1996). The present proposed project will begin evaluating the potential validity of this theory by assessing a key biological index (cortisol) that Melzack proposes to be intimately involved in the stress-pain interaction process. The better understanding of such a mechanism can potentially yield even more effective assessment and treatment approaches for chronic pain syndromes such as TMD.
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