STRESS RESPONSE IN PATIENTS WITH TEMPOROMANDIBULAR DISORDERS & FIBROMYALGIA

University Of Kentucky, Lexington KY

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Abstract

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The overall goal of this proposal is to define the relationships between symptom severity, stress exposure, and stress physiology of women with temporomandibular disorder (TMD) with and without concomitant fibromyalgia (FM). Our overall hypothesis is that individuals with TMD can have variable intensity of symptoms and that those with concomitant FM will fall on the severe end of the spectrum. Further, symptom severity will correlate with stress exposure (e.g. childhood vs adult, life events vs daily hassles) and stress physiology (e.g., salivary cortisol, heart-rate variability). We will recruit individuals from the University of Kentucky orofacial pain clinic and the Kentucky Women's Health Registry. Subjects will be classified into TMD without FM, TMD with FM, and healthy age matched controls. We will recruit 30 women with TMD anticipating that at least half will have comorbid FM, and 15 healthy controls. We are limiting this pilot study to women because the large majority of patients are women and because we will be evaluating stressors as they pertain to women. Stress perception and exposure will be evaluated using well-validated survey instruments. All subjects will undergo evaluation of stress-response physiology including diurnal cortisol and ambulatory heart-rate variability to monitor autonomic activity. The specific aims to be tested are as follows: Specific Aim 1: To compare temporomandibular disorder (TMD;n=30) in the presence or absence of fibromyalgia (FM) with regard to severity of symptoms and stress physiology. Specific Aim 2: To determine the association between psychosocial stress and distress and symptom profile, diagnostic groups (TMD [unreadable] FM, n=30, and healthy matched controls, n=15) and stress physiology. Stress exposure measures and psychosocial phenotyping include the MINI Neuropsychiatric Interview, SF-12v2, CES-D, Scl-90R, MASQ, PSQI, Gracely Pain Scale, McGill Pain Questionnaire, Hassles &Uplifts Sclare, Perceived Stress Scale, PCL-C, Job Content Questionnaire, National Violence Against Women Survey, and the Psychological Maltreatment of Womens Inventory. Stress physiology phenotyping includes diurnal salivary cortisol levels to assess baseline HPA axis function, salivary cortisol measurement at 30 minutes post-waking to assess stimulated HPA axis function, heart-rate variability, and skin conductance. We will also measure serum interleukin-6 (IL-6) and C-reactive protein (CRP) levels to assess generalized immune system activation.