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UMSOD Collaborates in Multi-Center Orofacial Pain Study

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Written by Adam Zewe

Innovative pain research conducted by University of Maryland School of Dentistry (UMSOD) investigators has been published in a special December issue of the Journal of Pain. The research is part of an ongoing, multi-center study that investigates temporomandibular joint disorders (TMD) to determine the causes and predictors of these chronic pain conditions. The collaborative study, Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA), involves UMSOD and four other institutions: the University of North Carolina at Chapel Hill, the University of Florida, the University of Buffalo and Battelle, Inc. The special issue of Pain features the second set of findings from this unprecedented research project, currently in its ninth year.

Among the findings, the researchers identify physiological, psychological and health factors that predict a patient's likelihood to develop TMD, explains Professor Joel Greenspan, PhD, chair of the Department of Neural and Pain Sciences and a lead author of the research papers. Of the 3,600 healthy people whom the researchers followed for up to five years, 260 developed TMD. By sending these patients questionnaires every three months and conducting follow-up testing, the scientists were able to identify several factors that are predictive of TMD development.

The most significant TMD predictor was the presence of another chronic pain condition. For example, patients who reported lower back pain were twice as likely to develop TMD as pain-free patients. Those who suffered from irritable bowel syndrome were three times more likely to develop TMD. "The co-occurrence of TMD and another pain problem occurs much more frequently than one would estimate statistically," Greenspan says.

Another potential predictor of TMD is a patient's sensitivity to pain. Psychological factors like stress, negative mood, and obsessive-compulsive tendencies could also predispose one to TMD development. "These results are important because they point out the many different factors that go along with TMD. We need to pay attention to many other things, rather than just focus on the jaw where the pain is," remarks Greenspan.

Beginning early next year, the OPPERA project will enter its third phase. The researchers will study patients as soon as they become symptomatic to understand why some recover while others develop chronic pain, and to learn what treatments are effective. They will also expand their study of co-morbid pain conditions to see how more specific conditions, like low back pain, fibromyalgia, tension headaches and migraine headaches, impact TMD. "This is the largest study of its kind. All of the researchers involved in OPPERA recognize that there is something historic about this work. What will come out of this collaboration will be much greater than what any one of us could have accomplished on our own," Greenspan says.

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