In 2011, the Institute of Medicine (IOM) made research on pain conditions such as temporomandibular disorders (TMD) among the highest priorities due to its high prevalence, functional limitations, missed work, opioid dependency, and high health care cost. The IOM also stated that health professionals' primary role for chronic pain should be guiding, coaching, and assisting patients with day-to-day self-management of chronic pain and recommended research involving self-management as one of the highest priorities. However, there is little research on innovative approaches to self-management of chronic pain, and health professionals often lack the time and training to perform this role. To support robust self-management, innovations in both web- based programs and the use of health coaches have been made to train patients in managing many chronic conditions, but there is limited research on its application to chronic pain, and none with TMD pain. Research in the fidelity, acceptability, outcomes, and sustainability of self-management training programs is much needed. We propose to evaluate an innovative patient-centered self-management program for TMD pain titled Personalized Activated Care and Training (PACT). PACT is a web-based, tailored 8-week program that is supported by a health coach to enhance understanding, compliance, and success in self-management of TMD pain. It uses well-tested cognitive-behavioral strategies to help patients reduce their specific lifestyle risk factors and enhance protective factors across all aspects of patients' lives to prevent chronic pain. The goal of this proposal is to conduct a pilot randomized clinical trial of the PACT program for TMD pain with the overall goal of determining feasibility and acceptability of methods and preliminary outcomes to power a multi-site randomized clinical trial of its efficacy. This proposal is the result of an 34 NIDCR planning grant, R34DE024260. In this proposed pilot study, we have 2 aims: 1) Evaluate the feasibility and acceptability of methods to recruit, consent, enroll and follow-up with participants; test instruments; and evaluate fidelity and adherence to the intervention and, 2) Describe preliminary program outcomes on standardized measures of pain severity, jaw function, and emotional status. We will recruit a total of 80 patients with TMD pain into either: 1 the PACT intervention arm (n=40) as described above or 2) a traditional self-care control arm (n=40) consisting of resting the jaw and encouraging healing such as soft diet, heat/cold, analgesics, and oral habit reduction. The interventions in both groups will be implemented through web-based formats over 8 weeks to match timing and computer literacy bias.
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 TMD pain and prevent chronic pain in patients with temporomandibular disorders compared with traditional self-care. This patient-centered program is designed to educate and engage patients in an 8-week personalized program of exercise and behavioral changes implemented through a web-based program supported by a health coach.
