This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor 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.
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