Ohrbach Richard, Dworkin Samuel F
Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York.
Departments of Psychiatry and Behavioral Sciences, and Oral Medicine, Schools of Medicine and Dentistry, University of Washington (Emeritus), Seattle, Washington.
J Pain. 2019 Nov;20(11):1276-1292. doi: 10.1016/j.jpain.2019.04.003. Epub 2019 Apr 18.
The classification of temporomandibular disorders (TMD) has progressed substantially over the past 25 years owing to the strategic implementation of an initial classification system based on core taxonomic principles. In this article, we describe the development of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and its translation into the multidimensional Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-AAPT for chronic pain disorders. The initial scientific classification system (Research Diagnostic Criteria for Temporomandibular Disorders) relied on a boot-strapping process that did not attempt to solve all known clinical problems but, rather, focused on problems that could be solved at that time. The core design principles included using epidemiologic data, operationalized concepts, reliable methods, and the incorporation of the biopsychosocial model into a dual axis system. This system led to sufficient data collection internationally that the system itself could be revised, first by critical evaluation of all aspects, second by review from invited experts, and third by the construction of a revised taxonomy (DC/TMD) that maintained the core design principles of the Research Diagnostic Criteria for Temporomandibular Disorders. The resultant disorders with pain as a dominant feature exhibit substantial sensitivity and specificity, and they have been translated into the AAPT framework. The AAPT TMD criteria are part of an evidence-based classification system providing a systematic structure that includes 5 dimensions: diagnostic criteria, common features, comorbidities, consequences, and putative mechanisms. Future research will attempt to extend this AAPT domain from solely TMDs to include other orofacial pain conditions. PERSPECTIVE: The painful TMDs have well-established sensitivity and specificity, as based on the DC/TMD; their translation to the AAPT framework for chronic pain conditions provides a structure for consistent clinical application within the broader health care settings and for future research on the TMDs.
在过去25年中，由于基于核心分类原则的初始分类系统的战略实施，颞下颌关节紊乱病（TMD）的分类有了显著进展。在本文中，我们描述了颞下颌关节紊乱病诊断标准（DC/TMD）的发展及其转化为用于慢性疼痛疾病的多维镇痛、麻醉和成瘾临床试验转化创新机遇与网络（AAPT）。最初的科学分类系统（颞下颌关节紊乱病研究诊断标准）依赖于一种逐步完善的过程，该过程并非试图解决所有已知的临床问题，而是专注于当时能够解决的问题。核心设计原则包括使用流行病学数据、可操作的概念、可靠的方法，以及将生物心理社会模型纳入双轴系统。该系统在国际上促成了充分的数据收集，从而能够对系统本身进行修订，首先是对各个方面进行批判性评估，其次是邀请专家进行审查，第三是构建一个修订后的分类法（DC/TMD），该分类法保留了颞下颌关节紊乱病研究诊断标准的核心设计原则。由此产生的以疼痛为主要特征的疾病表现出较高敏感性和特异性，并已转化为AAPT框架。AAPT TMD标准是基于证据的分类系统的一部分，提供了一个系统结构，包括五个维度：诊断标准、共同特征、合并症、后果和假定机制。未来的研究将试图将这个AAPT领域从单纯的TMD扩展到包括其他口面部疼痛疾病。观点：基于DC/TMD，疼痛性TMD具有公认的敏感性和特异性；将其转化为用于慢性疼痛疾病的AAPT框架，为在更广泛的医疗环境中进行一致临床应用以及对TMD进行未来研究提供了一个结构。
