Identifying Subgroups of Adolescents with Chronic Temporomandibular Disorder Pain to Guide Personalized Treatment

PROJECT SUMMARY/ABSTRACT Chronic pain in youth is often undertreated and/or neglected, leading to long-term consequences across the lifespan. The most common chronic pediatric orofacial pain complaint is temporomandibular disorder (TMD), a broad term which encompasses pain and/or dysfunction in the masticatory muscles, temporomandibular joint, and/or their associated structures. TMD pain affects up to 30% of adolescents, yet there is a general absence of studies concerning treatment strategies for its management in pediatric populations. Adolescents with TMD pain exhibit significant variability in their levels of pain and pain-related disability and distress, which is influenced by individual psychosocial factors and underlying physiology. To develop personalized, patient-oriented treatment approaches, it is crucial to identify distinct patient subgroups based on clinically relevant features, including physiologic outcomes, pain characteristics, and psychosocial factors, to determine which subgroups are more responsive to treatment. Physical self-regulation (PSR) is a biobehavioral intervention that directly targets the physiological and psychosocial elements that characterize individuals with TMD pain, through increasing a patient’s ability to individually self-regulate his/her physical and psychological state. The novel use of PSR in adolescents with chronic TMD pain holds promise for a personalized treatment regimen customized to an individual patient’s specific phenotypic profile. The long-term objective of our proposed research program is to identify subgroups of adolescents with chronic TMD pain who are more likely to respond to PSR treatment. A critical first step is to characterize individual phenotypic differences among adolescents presenting with chronic TMD pain. This application proposes to characterize physiologic processes associated with chronic TMD pain in adolescents using heart rate variability, salivary stress hormones and inflammatory cytokines, and quantitative sensory testing (Aim 1) and evaluate patient-reported outcome measures of pain characteristics and psychosocial factors using validated questionnaires (Aim 2) in order to identify distinct subgroups of adolescents with chronic TMD pain (Aim 3). Altogether, data generated from these aims will be used to guide the design and implementation of a randomized controlled trial to evaluate the efficacy of PSR among subgroups of adolescents with chronic TMD pain. Integration of a tailored, behavioral change intervention such as PSR has the potential to significantly improve the quality of life in not only adolescents with chronic TMD pain, but also youth suffering from other chronic pain conditions. Our interdisciplinary team is uniquely qualified to conduct the proposed work as we have the necessary experience, expertise, and facilities required to achieve our aims. This application includes collaboration between experienced and junior faculty across multiple disciplines to ensure the rigor and translation of our findings.