ingest cdrApp 2018-08-23T17:20:16.835Z d39a25df-af15-48e9-aec2-c9af81a997a2 modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-08-23T17:21:07.040Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2018-08-23T17:21:18.132Z Adding technical metadata derived by FITS addDatastream MD_FULL_TEXT fedoraAdmin 2018-08-23T17:21:41.392Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-08-23T17:22:03.798Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-27T17:59:45.618Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-21T19:13:34.125Z Vanessa Miller Author Department of Epidemiology Gillings School of Global Public Health Pain-related Disability Among People with Chronic Orofacial Pain Pain-related Disability Among People with Chronic Orofacial Pain High pain-related disability diminishes quality of life and increases health care costs. This study evaluated characteristics discriminating between high and low pain-related and examined the relationship between factors associated with pain-related disability among people with chronic painful temporomandibular disorder (TMD). We conducted a cross-sectional analysis of a community-based sample of 1088 individuals with chronic TMD who completed standardized questionnaires assessing four domains: 1) sociodemographic, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high pain-related disability, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate contributions of variables from each domain. Cross-validated area under the ROC curve (AUC) quantified model discrimination. We re-validated this measure of pain-related disability and created measurement models of TMD clinical features, psychological distress, and experimental pain sensitivity. Latent variables were combined for a full structural equation model that was crafted with exploratory model changes. Participants were 18-44 years old (mean 29.2, SD + 7.8) with a mean duration of 6.9 (6.4) years of chronic TMD. A third of participants had high pain-related disability. An 18-variable model encompassing all four domains had good discrimination (AUC=0.79 95% CI 0.75,0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites: AUC=0.79 95% CI 0.76,0.82). Duration of pain, gender, and experimental pain testing results were not predictive. Our structural equation model of pain-related disability, TMD features, and psychological distress was created and refined based on exploratory model revisions. Estimation of the final model indicated a good fit with the data. TMD clinical features and psychological distress predicted pain-related disability but experimental pain sensitivity did not. The final model explained 78% of the variance in pain-related disability. High-impact chronic pain is a common problem among people with painful TMD. Assessment of characteristics associated with high-impact pain can be easily performed to identify modifiable risk factors and reduce high-impact pain. TMD clinical features (specifically jaw limitation) and psychological distress (including negative affect, somatization, and catastrophizing) should be considered by clinicians and researchers addressing pain-related disability. Summer 2018 2018 Epidemiology Chronic pain, Pain impact, Pain-related disability, Quality of life, Structural equation modeling, Temporomandibular disorder eng Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gary Slade Thesis advisor Charles Poole Thesis advisor Yvonne Golightly Thesis advisor Deborah Barrett Thesis advisor Ding-Gen Chen Thesis advisor text Vanessa Miller Creator Department of Epidemiology Gillings School of Global Public Health Pain-related Disability Among People with Chronic Orofacial Pain Pain-related Disability Among People with Chronic Orofacial Pain High pain-related disability diminishes quality of life and increases health care costs. This study evaluated characteristics discriminating between high and low pain-related and examined the relationship between factors associated with pain-related disability among people with chronic painful temporomandibular disorder (TMD). We conducted a cross-sectional analysis of a community-based sample of 1088 individuals with chronic TMD who completed standardized questionnaires assessing four domains: 1) sociodemographic, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high pain-related disability, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate contributions of variables from each domain. Cross-validated area under the ROC curve (AUC) quantified model discrimination. We re-validated this measure of pain-related disability and created measurement models of TMD clinical features, psychological distress, and experimental pain sensitivity. Latent variables were combined for a full structural equation model that was crafted with exploratory model changes. Participants were 18-44 years old (mean 29.2, SD + 7.8) with a mean duration of 6.9 (6.4) years of chronic TMD. A third of participants had high pain-related disability. An 18-variable model encompassing all four domains had good discrimination (AUC=0.79 95% CI 0.75,0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites: AUC=0.79 95% CI 0.76,0.82). Duration of pain, gender, and experimental pain testing results were not predictive. Our structural equation model of pain-related disability, TMD features, and psychological distress was created and refined based on exploratory model revisions. Estimation of the final model indicated a good fit with the data. TMD clinical features and psychological distress predicted pain-related disability but experimental pain sensitivity did not. The final model explained 78% of the variance in pain-related disability. High-impact chronic pain is a common problem among people with painful TMD. Assessment of characteristics associated with high-impact pain can be easily performed to identify modifiable risk factors and reduce high-impact pain. TMD clinical features (specifically jaw limitation) and psychological distress (including negative affect, somatization, and catastrophizing) should be considered by clinicians and researchers addressing pain-related disability. Epidemiology Chronic pain; Pain impact; Pain-related disability; Quality of life; Structural equation modeling; Temporomandibular disorder Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Gary Slade Thesis advisor Charles Poole Thesis advisor Yvonne Golightly Thesis advisor Deborah Barrett Thesis advisor Ding-Gen Chen Thesis advisor 2018 2018-08 eng text Vanessa Miller Creator Department of Epidemiology Gillings School of Global Public Health Pain-related Disability Among People with Chronic Orofacial Pain High pain-related disability diminishes quality of life and increases health care costs. This study evaluated characteristics discriminating between high and low pain-related and examined the relationship between factors associated with pain-related disability among people with chronic painful temporomandibular disorder (TMD). We conducted a cross-sectional analysis of a community-based sample of 1088 individuals with chronic TMD who completed standardized questionnaires assessing four domains: 1) sociodemographic, 2) psychological distress, 3) clinical pain, and 4) experimental pain. We used high pain-related disability, classified using the Graded Chronic Pain Scale, as the dependent variable in logistic regression modeling to evaluate contributions of variables from each domain. Cross-validated area under the ROC curve (AUC) quantified model discrimination. We re-validated this measure of pain-related disability and created measurement models of TMD clinical features, psychological distress, and experimental pain sensitivity. Latent variables were combined for a full structural equation model that was crafted with exploratory model changes. Participants were 18-44 years old (mean 29.2, SD + 7.8) with a mean duration of 6.9 (6.4) years of chronic TMD. A third of participants had high pain-related disability. An 18-variable model encompassing all four domains had good discrimination (AUC=0.79 95% CI 0.75,0.82), as did a simplified model (sociodemographic variables plus catastrophizing, jaw limitation, and number of painful body sites: AUC=0.79 95% CI 0.76,0.82). Duration of pain, gender, and experimental pain testing results were not predictive. Our structural equation model of pain-related disability, TMD features, and psychological distress was created and refined based on exploratory model revisions. Estimation of the final model indicated a good fit with the data. TMD clinical features and psychological distress predicted pain-related disability but experimental pain sensitivity did not. The final model explained 78% of the variance in pain-related disability. High-impact chronic pain is a common problem among people with painful TMD. Assessment of characteristics associated with high-impact pain can be easily performed to identify modifiable risk factors and reduce high-impact pain. TMD clinical features (specifically jaw limitation) and psychological distress (including negative affect, somatization, and catastrophizing) should be considered by clinicians and researchers addressing pain-related disability. Epidemiology Chronic pain; Pain impact; Pain-related disability; Quality of life; Structural equation modeling; Temporomandibular disorder Doctor of Public Health Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Gary Slade Thesis advisor Charles Poole Thesis advisor Yvonne Golightly Thesis advisor Deborah Barrett Thesis advisor Ding-Gen Chen Thesis advisor 2018 2018-08 eng text Miller_unc_0153D_18076.pdf uuid:05db1a2d-3d5d-4def-b7dd-3e7aacb70ab2 2020-08-23T00:00:00 2018-07-25T19:01:38Z proquest application/pdf 1491507