For over 20 years The TMJ Association's advocacy efforts have resulted in congressional report language, in which funding committees communicate to federal agencies, such as the National Institutes of Health (NIH), that our elected officials are concerned about the plight of TMD patients and propose initiatives needed to improve their health care and lives. These directives have a powerful influence on the decisions made by the government agencies, in particular, the individual components of the NIH. We have established personal contacts with congressional staff and elected representatives and garnered their support by reporting regularly on the state of TMD research and letting them know what we, the patients, need. It is gratifying to report that Congress responds to the needs of the TMD patients and tracks the progress the NIH has made and continues to make on their behalf.
For these devastating conditions we want the best science this country has to offer and we are fortunate to have the support of members of the Senate Labor, Health and Human Services, Education and Related Services Appropriations Subcommittee, responsible for funding the National Institutes of Health (NIH). This support deserves our thanks; take a moment to send a note of appreciation to the committee members.
Report Language appearing in the FY2018 Appropriations Bills:
Temporomandibular Disorders [TMD]
[Office of the Director] The Committee understands that NIH-funded research has demonstrated that temporomandibular disorders [TMD] are primarily a multisystem disorder with overlapping conditions influenced by multiple biological and environmental factors rather than solely an orofacial pain condition. However, diagnosis and care of patients have not changed to reflect this major paradigm shift, with many patients continuing to receive treatments solely focused on teeth and jaws. Moreover, the medical community lacks education regarding the complexity and systemic aspects of TMD as well as its many comorbid medical conditions. Patients are treated by a multitude of practitioners across numerous disciplines with treatments that have the potential to cause harm. To address these issues, the Committee requests that NIH provide an update on the state of TMD research, activities related to TMD education, and clinical studies of TMD in the fiscal year 2019.
[National Institute of Dental and Craniofacial Research (NIDCR)] The Committee recognizes NIDCR’s leadership in TMD pain research, which has led to establishing TMD as a multisystem disorder with overlapping pain and non-pain conditions. The Committee encourages NIDCR to continue its leadership as a critical member of the Trans-NIH Working Group on Chronic Overlapping Pain Conditions by promoting and advancing integrated research on these conditions. In addition, as the oral disability associated with TMD affects a patient’s nutritional health status, the Committee encourages NIDCR to improve research on orofacial function relevant to the nutritional implications of TMD. Finally, the Committee is aware of the scientific meetings on an integrated systems approach of precision medicine related to cellular-molecular-genetic-epigenetic mechanisms related to diagnosis and treatment of TMD and its comorbid conditions. In 2013, several Institutes co-sponsored a workshop on the topic of the temporomandibular joint. The Committee requests an update on initiatives that resulted from the recommendations that came forth from these meetings in the fiscal year 2019.
Chronic Overlapping Pain Conditions
[Office of the Director] The Committee notes the strong evidence base demonstrating deleterious outcomes for patients with Chronic Overlapping Pain Conditions, which include hit-or-miss, ineffective, or even harmful treatments, poor health and quality of life outcomes, markedly increased disability rates and personal and societal financial burdens. The Committee is pleased with NIH’s efforts to develop a chronic overlapping pain conditions screening tool. However, an expanded, coordinated, and collaborative initiative is needed to maximize the Federal research investment, reduce spending, and improve clinical practice. There is an urgent need to analyze the state of science on Chronic Overlapping Conditions, which will identify both research gaps and future research directions and collaborations. As such, the Committee urges the Director to consider the relevant recommendations of the Federal Pain Research Strategy to guide the development of a comprehensive effort that spans the basic, translational, and clinical research continuum to advance scientific understanding of chronic overlapping pain conditions, as well as the development and discovery of safe and effective treatments.
The NIH, one of 10 federal agencies under the direction of the U.S. Department of Health and Human Services, is the primary federal agency that conducts and supports medical research. With the support of the American people, the NIH annually invests over $30 billion in medical research. The NIH is comprised of 27 Institutes and Centers. It provides leadership and financial support to researchers in every state, and throughout the world. Helping to lead the way toward important medical discoveries that improve people's health and save lives, NIH scientists investigate ways to prevent disease, work to determine causes, and establish treatments, and even cures for common and rare diseases. One of those 27 components is the National Institute of Dental and Craniofacial Research (NIDCR), which supports the bulk of research on TMD. Now that scientific understanding has uncovered the neurological and other complexities of Temporomandibular Disorders (TMD), an increasing number of agencies of the NIH are recognizing that they have a significant role in solving the puzzle of TMD by also providing funding for integral research programs.