Temporomandibular Joint and Muscle Disorders
NIH Supports a Wide Range of Research Gao ID: GAO-08-454R April 4, 2008Temporomandibular joint and muscle disorders (TMJD) include a heterogeneous group of disorders with overlapping--but not identical--signs and symptoms. Symptoms of TMJDs vary, but typically include pain in the jaw joint and surrounding muscles. Other symptoms may include limited or no movement of the jaw joint, clicking or grating in the jaw joint when opening or closing the mouth, headaches, and shoulder or back pain. Most people with TMJDs have relatively mild forms of these disorders with symptoms that diminish without treatment. However, a small number of individuals develop significant, long-term problems, including persistent and debilitating pain and loss of jaw function. Although some TMJDs are due to a specific known cause, such as jaw injury or arthritis, the causes of many TMJDs are unknown. While the level of understanding about these conditions has evolved with scientific advancements, diagnosis and treatment are difficult because the exact causes and patterns of symptoms remain unclear. The National Institutes of Health (NIH), an agency within the Department of Health and Human Services (HHS), funds research on the causes of, treatments for, and other aspects of TMJDs. The NIH is organized into 27 institutes and centers and the Office of the Director, each with its own mission and functions. Through these institutes and centers, NIH supports both extramural research--conducted at external research institutions by scientists who are awarded funds to support their work--and intramural research conducted by its own scientists. In 1996, NIH sponsored a Technology Assessment Conference that included a panel of experts from a variety of fields, including clinical dentistry, medicine, surgery, immunology, behavioral and social sciences, and pain management. The panel addressed, among other things, the effective management and treatment of patients with TMJDs and the most productive directions for future research, including both applied and basic research. The panel concluded there was a clear need for applied research on a number of issues, including the prevalence of TMJD symptoms, predisposing and precipitating conditions, diagnostic methods, and treatment outcomes. It also concluded that there was a need for basic research in areas such as pain and biomechanics. Noting that TMJDs continue to pose complex health problems for the American public, you expressed interest in the progress that has been made in acting on the panel's conclusions. GAO is reporting on (1) TMJD-related research activities that NIH supported from fiscal year 2002 through fiscal year 2006, and (2) NIH's plans to support future research on TMJDs.
NIH supported a wide range of TMJD-related research from fiscal year 2002 through fiscal year 2006. GAO identified 170 TMJD-related projects supported by NIH during this time period. These projects varied in the types of research activities involved, the institutes and centers that supported them, and the questions the research was designed to investigate. Specifically, NIH supported a variety of different research activities through, for example, grants to support discrete projects performed by investigators in their specific area of interest and grants to support organized efforts of several investigators conducting related research projects. Most of the projects we identified were supported by NIH's National Institute of Dental and Craniofacial Research (NIDCR); nine other institutes and centers and the Office of the Director also supported TMJD-related projects. The research supported by NIH during this time period addressed a wide range of questions related to TMJDs. For example, research addressed questions about the prevalence of TMJD signs and symptoms, predisposing and precipitating conditions, gender differences in TMJDs, pain, and biomechanics. NIH officials told GAO that the agency plans to support future research on TMJDs by continuing to fund research it finds meritorious, including research applications submitted in response to targeted funding announcements. Several targeted funding announcements issued from December 2005 through December 2007 signaled NIH's interest in supporting research in areas involving TMJDs. These announcements either focused directly on TMJDs or addressed research areas, such as pain, that could include TMJDs. Specifically, NIH signaled interest in receiving applications in one area of research that directly focused on TMJDs--the co-occurrence of TMJDs with other chronic conditions, such as chronic fatigue syndrome. During the same 2-year time period, NIH signaled interest in receiving applications addressing 15 other areas of research that identified TMJDs as a possible focus, but did not require investigators to include TMJDs as a focus of their research proposal. NIH officials reported that they may issue additional targeted funding announcements to encourage future research on specific aspects of TMJDs.
GAO-08-454R, Temporomandibular Joint and Muscle Disorders: NIH Supports a Wide Range of Research
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April 4, 2008:
The Honorable Edward M. Kennedy:
Chairman:
Committee on Health, Education, Labor, and Pensions:
United States Senate:
Dear Mr. Chairman:
Subject: Temporomandibular Joint and Muscle Disorders: NIH Supports a
Wide Range of Research:
Temporomandibular joint and muscle disorders (TMJD) include a
heterogeneous group of disorders with overlapping--but not identical--
signs and symptoms.[Footnote 1] Symptoms of TMJDs vary, but typically
include pain in the jaw joint and surrounding muscles. Other symptoms
may include limited or no movement of the jaw joint, clicking or
grating in the jaw joint when opening or closing the mouth, headaches,
and shoulder or back pain. Most people with TMJDs have relatively mild
forms of these disorders with symptoms that diminish without
treatment.[Footnote 2] However, a small number of individuals develop
significant, long-term problems, including persistent and debilitating
pain and loss of jaw function.[Footnote 3] Although some TMJDs are due
to a specific known cause, such as jaw injury or arthritis, the causes
of many TMJDs are unknown. While the level of understanding about these
conditions has evolved with scientific advancements, diagnosis and
treatment are difficult because the exact causes and patterns of
symptoms remain unclear.
The National Institutes of Health (NIH), an agency within the
Department of Health and Human Services (HHS), funds research on the
causes of, treatments for, and other aspects of TMJDs. The NIH is
organized into 27 institutes and centers and the Office of the
Director, each with its own mission and functions. Through these
institutes and centers, NIH supports both extramural research--
conducted at external research institutions by scientists who are
awarded funds to support their work--and intramural research conducted
by its own scientists. In 1996, NIH sponsored a Technology Assessment
Conference that included a panel of experts from a variety of fields,
including clinical dentistry, medicine, surgery, immunology, behavioral
and social sciences, and pain management.[Footnote 4] The panel
addressed, among other things, the effective management and treatment
of patients with TMJDs and the most productive directions for future
research, including both applied and basic research.[Footnote 5] The
panel concluded there was a clear need for applied research on a number
of issues, including the prevalence of TMJD symptoms, predisposing and
precipitating conditions, diagnostic methods, and treatment outcomes.
It also concluded that there was a need for basic research in areas
such as pain and biomechanics.[Footnote 6]
Noting that TMJDs continue to pose complex health problems for the
American public, you expressed interest in the progress that has been
made in acting on the panel's conclusions. We are reporting on (1) TMJD-
related research activities that NIH supported from fiscal year 2002
through fiscal year 2006, and (2) NIH's plans to support future
research on TMJDs.
To identify TMJD-related research activities supported by NIH from
fiscal years 2002 through 2006, we examined data provided to us by NIH
that listed projects on, or related to, TMJDs that it funded during
that time period.[Footnote 7] Because we learned that some NIH
institutes and centers did not begin reporting TMJD-related projects
until after fiscal year 2002 and that institutes and centers differed
in their methods for determining whether projects were TMJD-related, we
validated the list of projects NIH provided. We took several steps to
do so. For each listed project, we reviewed an abstract or other
documentation, such as a progress report, to confirm that it was TMJD-
related. We also developed a list of potentially relevant projects
through a keyword search of HHS's publicly available Computer Retrieval
of Information on Scientific Projects (CRISP) database. We then
compared NIH's list to those we identified through our CRISP search.
When we identified discrepancies between the lists, we obtained
clarifying information from NIH officials and reached agreement about
whether to include or exclude specific projects. Based on these
analyses and discussions, we determined that our final list of TMJD-
related projects supported by NIH from fiscal years 2002 through 2006
was sufficiently reliable and valid for our purposes.
To identify NIH's plans to support future research on TMJDs, we
reviewed targeted funding announcements--public announcements that
describe specific areas of research that NIH is interested in funding-
-released from December 2005 through December 2007. We identified
relevant funding announcements by conducting a keyword search of NIH's
online Guide for Grants and Contracts that is available through NIH's
Office of Extramural Research Web site.[Footnote 8] We discussed NIH's
plans to support future research on TMJDs with agency officials. In
addition, we interviewed representatives of three TMJD advocacy groups
to help us understand their perspectives on research related to TMJDs.
These three advocacy groups were the American Alliance of TMD
Organizations, the Jaw Joints & Allied Musculo-Skeletal Disorders
Foundation, and the TMJ Association. Enclosure I contains additional
information about our scope and methodology.
We conducted this performance audit from February 2007 through March
2008 in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives.
Results in Brief:
NIH supported a wide range of TMJD-related research from fiscal year
2002 through fiscal year 2006. We identified 170 TMJD-related projects
supported by NIH during this time period. These projects varied in the
types of research activities involved, the institutes and centers that
supported them, and the questions the research was designed to
investigate. Specifically, NIH supported a variety of different
research activities through, for example, grants to support discrete
projects performed by investigators in their specific area of interest
and grants to support organized efforts of several investigators
conducting related research projects. Most of the projects we
identified were supported by NIH's National Institute of Dental and
Craniofacial Research (NIDCR); nine other institutes and centers and
the Office of the Director also supported TMJD-related projects. The
research supported by NIH during this time period addressed a wide
range of questions related to TMJDs. For example, research addressed
questions about the prevalence of TMJD signs and symptoms, predisposing
and precipitating conditions, gender differences in TMJDs, pain, and
biomechanics.
NIH officials told us that the agency plans to support future research
on TMJDs by continuing to fund research it finds meritorious, including
research applications submitted in response to targeted funding
announcements. Several targeted funding announcements issued from
December 2005 through December 2007 signaled NIH's interest in
supporting research in areas involving TMJDs. These announcements
either focused directly on TMJDs or addressed research areas, such as
pain, that could include TMJDs. Specifically, NIH signaled interest in
receiving applications in one area of research that directly focused on
TMJDs--the co-occurrence of TMJDs with other chronic conditions, such
as chronic fatigue syndrome. During the same 2-year time period, NIH
signaled interest in receiving applications addressing 15 other areas
of research that identified TMJDs as a possible focus, but did not
require investigators to include TMJDs as a focus of their research
proposal. NIH officials reported that they may issue additional
targeted funding announcements to encourage future research on specific
aspects of TMJDs.
HHS provided technical comments on a draft of this report, which we
incorporated as appropriate.
Background:
The goals of NIH-supported research are to advance the understanding of
biological systems, improve the control of disease, and enhance health.
NIH has recognized the need for research on TMJDs to develop a better
understanding of the onset and natural course of these disorders and to
develop new diagnostic and treatment approaches. NIH reported that its
institutes and centers obligated about $90.6 million for TMJD-related
extramural and intramural research in fiscal years 2002 through
2006.[Footnote 9]
Temporomandibular Joint and Muscle Disorders:
Although much remains unknown about TMJDs, the level of understanding
about them has evolved over time. For example, since the 1996
Technology Assessment Conference, it has become apparent that
individuals with TMJDs often experience other chronic and painful
disorders, such as chronic fatigue syndrome, fibromyalgia, and
irritable bowel syndrome.[Footnote 10] In addition, subsequent research
has found that women in their childbearing years are more likely than
men or than younger or older women to seek care for TMJDs, suggesting a
possible role of female sex hormones in TMJDs.[Footnote 11]
NIH's Structure and Processes for Supporting Research:
NIH institutes and centers accomplish their mission chiefly by funding
extramural research. NIH states that it seeks to fund high-caliber,
unique, and investigator-initiated research that is relevant to public
health needs. NIH funds research primarily by providing support for
investigator-initiated applications that are submitted independently or
in response to targeted funding announcements, with funding decisions
made according to NIH priority areas, including TMJDs. Approximately 84
percent of NIH's budget--a total of about $29 billion in fiscal year
2007--supports extramural research. This extramural research is
supported primarily by grants, but also through cooperative agreements
and contracts.[Footnote 12] NIH also supports intramural research,
conducted by scientists working in its own laboratories and clinical
center. Approximately 10 percent of NIH's budget supports intramural
research.[Footnote 13]
NIH awards a variety of types of grants to support extramural research,
and each type of grant supports a specific type of research activity.
For example:
* Some grants support discrete research efforts by specific
investigators. The most common type of grant--a research project grant-
-is used to support a specified, circumscribed project, traditionally
under the direction of a single principal investigator.[Footnote 14]
The research project grant is typically awarded for a period of 3 to 5
years to support research in an area representing the investigator's
specific interest and competencies.[Footnote 15] Small research grants
support research that can be carried out in a short period of time with
limited resources. Exploratory or developmental grants are designed to
encourage the development of new research activities in the early and
conceptual stages.
* Other NIH grants, including center and research program project
grants, support multiple research efforts. For example, a research
program project grant is designed to support a broadly based,
multidisciplinary program that has a specific major objective or basic
theme. This type of grant is used to support research that generally
involves the organized efforts of several investigators conducting
related research projects. Similarly, a general clinical research
center grant is designed to support a research unit within a hospital,
for example, where scientists conduct studies on a wide range of
issues.[Footnote 16] Another type of grant--a specialized center grant-
-is designed to support multidisciplinary research, both basic and
clinical, on a specific disorder or biomedical issue.
* NIH also provides fellowships and research career development grants
to help individuals obtain research training or pursue their research
careers. One such grant helps individuals who have completed doctoral
training obtain additional research training to broaden their
scientific background and increase their potential for research.
* NIH also has conference grants to support organized meetings where
people exchange information.
(See table 1 for examples of NIH's grants and the types of research
activities they support.)
Table 1: Examples of Extramural Research Grants:
Type of grant: Research Projects: Research project grant;
Supported research activities: A discrete, circumscribed project,
usually under the direction of a single principal investigator and
typically awarded for a period of 3 to 5 years.
Type of grant: Research Projects: Small research grant;
Supported research activities: Research that can be carried out in a
short period of time with limited resources.
Type of grant: Research Projects: Exploratory/developmental grant;
Supported research activities: New research activities in the early and
conceptual stage.
Type of grant: Centers and programs: Research program project grant;
Supported research activities: A broadly based, multidisiciplinary
program that typically has a specific major objective and generally
involves several investigators conducting related research.
Type of grant: Centers and programs: General clinical research center
grant;
Supported research activities: A research unit within a hospital or
other inpatient care facility where scientists conduct studies on a
wide range of issues.
Type of grant: Centers and programs: Specialized center grant;
Supported research activities: Multidisciplinary research, both basic
and clinical, on a specific disorder or biomedical issue.
Type of grant: Fellowships and research career development:
Postdoctoral individual National Research Service award;
Supported research activities: Research training for individuals who
have completed a doctoral degree.
Type of grant: Fellowships and research career development: Mentored
patient-oriented research career development award;
Supported research activities: Supervised study and research for
clinically trained professionals who have the potential to develop into
productive, clinical investigators focusing on patient-oriented
research.
Source: GAO analysis of information from NIH.
[End of table]
Although most extramural grant applications submitted to NIH for
funding are unsolicited--that is, submitted in the absence of a
targeted announcement--NIH can signal particular interest in specific
areas by issuing targeted funding announcements on specific topics of
high priority. Targeted funding announcements include, for example,
program announcements and requests for applications.[Footnote 17]
Program announcements describe areas of research that NIH is interested
in funding, but for which it has generally not set funds aside.
Requests for applications describe areas of research for which NIH has
set funds aside.
NIH evaluates grant applications for extramural research support using
a two-tiered system of peer review that reflects assessment of key
factors, such as scientific merit and NIH priorities. First,
applications are reviewed for scientific and technical merit by review
groups composed primarily of nongovernment scientists who are experts
in relevant fields of research. Based on this review, each application
is given a "priority score" that becomes the main determinant in
whether an applicant will eventually receive funding for the research
proposal. A second level of peer review is conducted by the relevant
institute's or center's National Advisory Council or Board, which
includes both scientific and lay representatives. The council or board
reviews applications not only for scientific and technical merit, but
also for their relevance to the institute's or center's programs and
priorities. Institute and center directors make the final funding
decisions among the top priority applications. According to NIH
officials, institute and center directors may decide to fund certain
applications that fall just outside the normal priority score
percentile cutoff if the research is of particular interest to the
institute or center--for example, if the research falls within one of
the high-priority areas described in one of the institute's or center's
targeted funding announcements[Footnote 18].:
NIH's Structure for Supporting Research on TMJDs:
Within NIH, NIDCR has primary responsibility for research on
TMJDs.[Footnote 19] Other institutes and centers may fund TMJD-related
research to the extent that the research is consistent with their
programs and priorities.[Footnote 20] For example, the National
Institute of Arthritis and Musculoskeletal and Skin Diseases may fund
research on those TMJDs associated with arthritis, and the Office of
Research on Women's Health (ORWH), within the Office of the Director,
may contribute funding toward research on gender differences in TMJDs.
Two NIH committees facilitate coordination among institutes and centers
on issues related to TMJDs. First, the Temporomandibular Muscle and
Joint Disorders Interagency Working Group is a committee that meets
annually to facilitate cooperation, communication, and collaboration
among NIH institutes and centers and other federal agencies that
conduct or support TMJD-related activities[Footnote 21]. Second, NIH's
Pain Consortium seeks to enhance pain research across NIH and to
promote collaboration among institutes and centers with programs and
activities addressing pain, including the pain associated with TMJDs.
These committees provide a forum for the exchange and dissemination of
information and can facilitate the coordination of activities,
including the development of targeted funding announcements, across
institutes and centers.
NIH Supported a Wide Range of TMJD-Related Research:
NIH has supported a range of different types of research addressing a
variety of questions related to TMJDs. We identified 170 TMJD-related
projects supported by NIH during fiscal years 2002 through
2006.[Footnote 22] These projects varied in the types of research
activities involved, the institutes and centers that supported them,
and the questions the research was designed to investigate.
NIH supported a variety of research activities related to TMJDs. Of the
170 projects we identified, 55 were extramural research project grants.
In addition, we found that NIH supported extramural centers and
research program projects (2 specialized centers, 1 comprehensive
center, 1 research program project, and 56 subprojects of other
research program projects or centers),[Footnote 23] extramural
fellowships and research career programs, including career development
awards[Footnote 24] (17 projects), extramural conferences (6 projects),
other types of extramural research (such as small research grants and
grants for exploratory or developmental research--27 projects,
including 1 research and development contract and 3 cooperative
agreements), and intramural research (5 projects). See enclosure II for
a list of the 170 NIH-supported projects related to TMJDs funded from
fiscal years 2002 through 2006.
Most of the TMJD-related projects supported by NIH from fiscal years
2002 through 2006 were funded through NIDCR. Nine other NIH institutes
and centers and the Office of the Director also funded TMJD-related
projects. Specifically, NIDCR was the primary sponsor of 103 of the 170
projects we identified--that is, NIDCR had administrative
responsibility for these projects. Other institutes and centers that
were primary sponsors of TMJD-related research included the National
Center for Research Resources (48 projects), National Institute of
Biomedical Imaging and Bioengineering (6 projects), National Institute
of Neurological Disorders and Stroke (4 projects), National Center for
Complementary and Alternative Medicine (3 projects), National Institute
of Arthritis and Musculoskeletal and Skin Diseases (2 projects),
National Institute of Mental Health (2 projects), National Institute of
Child Health and Human Development (1 project), and National Institute
on Drug Abuse (1 project). Some of these institutes and centers, along
with the National Institute on Deafness and Other Communication
Disorders and two offices within the Office of the Director--ORWH and
the Office of Rare Diseases--also provided additional support for TMJD-
related research by cofunding one or more of these projects.
NIH supported research that addressed a wide range of questions related
to TMJDs, including topics identified by the panel from the 1996
Technology Assessment Conference as research needs. NIH supported
projects to address such questions as the prevalence of TMJD signs and
symptoms, predisposing and precipitating conditions, treatment
outcomes, and gender differences in TMJDs and related comorbid
conditions. NIH also supported basic research on questions about such
issues as pain and biomechanics. These projects included multiple
studies on each of several topics that NIDCR officials identified as
most critical to advancing a scientific understanding of TMJDs--risk
factors, pathophysiology,[Footnote 25] pain mechanisms, the structure
and function of the temporomandibular joint, comorbidities, treatments
(including early intervention), sex and gender differences in TMJDs,
and animal models of TMJDs. Although a few examples cannot illustrate
the full range of TMJD-related research supported by NIH from fiscal
years 2002 through 2006, the following examples illustrate some aspects
of NIH's support for research on questions related to TMJDs:
* NIDCR began funding a research project entitled "Orofacial Pain:
Prospective Evaluation and Risk Assessment," or OPPERA in fiscal year
2005. This project, the first large-scale prospective study of TMJDs,
is a clinical study intended to identify risk factors that contribute
to the development of TMJDs by collecting a wide range of biological
and behavioral data from people before they develop these disorders.
Researchers plan to evaluate and monitor 3,200 volunteers--people who
are initially free from TMJDs--for 3 to 5 years. This project is
expected to provide important data about genetic, biological, and
psychological factors associated with the development of TMJDs. It is
also expected to provide information about the signs, symptoms, and
course of these disorders once they do develop. Funded through a
cooperative agreement, the research will be conducted at four
universities.
* NIH funded a research project entitled "Brief Focused Treatment for
TMD: Mechanisms of Action" to obtain information about certain
treatments for TMJDs. Specifically, this project was designed to
compare the effectiveness of a standard treatment for TMJDs--use of an
intraoral splint[Footnote 26] and anti-inflammatory drugs--with and
without cognitive-behavioral therapy, as well as to obtain information
about predictors of treatment effectiveness. This project was funded by
NIDCR and cofunded by ORWH from fiscal years 2003 through 2006.
Additional support was provided through a general clinical research
center grant from the National Center for Research Resources.
* NIH awarded a grant for a specialized center of research to support
interdisciplinary studies, including both clinical and basic research.
These studies were designed to address gender-related factors (such as
hormones) that influence pain and the development of TMJDs and other
pain-related conditions (such as irritable bowel syndrome). This
project, entitled "ORWH: SCOR[Footnote 27] on Sex and Gender Factors
Affecting Women's Health," was managed through the National Institute
of Arthritis and Musculoskeletal and Skin Diseases, which also provided
some funds for the project; the majority of funds were from ORWH. The
project was funded from fiscal years 2002 through 2006.
* A career development award entitled "Spatial and Temporal
Characteristics of Central Sensitization in Chronic Pain Diseases"
supported research designed to illuminate certain pain mechanisms
involved in chronic pain disorders. Specifically, research supported
through this award was intended to clarify the conditions under which
chronic pain causes an increase in sensitivity to pain, so that painful
stimuli are perceived as even more painful, or previously nonpainful
stimuli become painful. Funding for this project was awarded by the
National Institute of Neurological Disorders and Stroke from fiscal
years 2002 through 2006.
* A research project grant entitled "The Role of Tooth Mechanoreceptors
in Jaw Movement" provides an example of NIH's support for research on
the biomechanics of the temporomandibular joint. This project was
designed to obtain information about the nerves that carry information
from deep orofacial regions to the central nervous system, the normal
processes involved in sensory feedback from craniofacial nerves, and
how those processes are altered in disorders such as TMJDs. This
project was supported by NIDCR from fiscal years 2002 through 2006.
* A career transition award entitled "Accelerated Osteoarthritis in the
TMJ of Biglycan/Fibromodilin DKO Mice" supported research designed to
identify ways of preventing osteoarthritis of the temporomandibular
joint by detecting it and treating it at an early stage. This research
on the pathophysiology of TMJDs was designed to be conducted with mice
that provide a model of osteoarthritic-like TMJD. It was intended to
assess the role of mechanical loading on the progression of
osteoarthritis of the temporomandibular joint[Footnote 28] and the
biomarkers of osteoarthritis in this joint. It was also designed to
examine proteins that are involved in the proliferation and death of
cells in the cartilaginous portion of the temporomandibular joint.
Funding for this project was awarded by NIDCR in fiscal year 2006.
NIH officials noted that, in addition to supporting research that is
specifically related to TMJDs, NIH also supports a wide range of
research that is not specifically related to TMJDs, but is nonetheless
of potential relevance. For example, NIH supports research on related
topics such as pain, gender differences in health, and conditions that
are frequently comorbid with TMJDs. Information gained through such
research has the potential to contribute to the scientific
understanding of TMJDs, even though these projects were not
specifically designed to do so.
NIH Plans to Continue Supporting Research on TMJDs:
NIH officials told us that they plan to support future research on
TMJDs by continuing to fund research applications found to be
meritorious, including those submitted in response to targeted funding
announcements. Several funding announcements issued from December 2005
through December 2007 signaled NIH's interest in supporting research in
areas involving TMJDs, either by focusing directly on TMJDs or by
addressing other areas, such as pain, that could include TMJDs. (See
enc. III for a list of the areas of research addressed in the targeted
funding announcements.) Specifically, NIH signaled interest in
receiving applications in one research area that focused directly on
TMJDs--the co-occurrence of TMJDs with other chronic conditions such as
chronic fatigue syndrome and fibromyalgia. Three funding announcements
on this topic, entitled "Temporomandibular Joint and Muscle Disorders:
Pathophysiological Mechanisms Linking Comorbid Conditions," were
identical in scientific scope; they differed in the type of research
activity for which support could be made available. One of these
funding announcements addressed research project grants, a second
addressed small research grants, and the third addressed exploratory/
developmental grants.[Footnote 29] NIDCR issued these funding
announcements in March and December of 2006, and other institutes
indicated potential interest in funding some of this work. These three
announcements will expire in May 2009.[Footnote 30]
Other targeted funding announcements issued during this same 2-year
time period signaled NIH's interest in supporting research in areas
that could include--but are not required to include--TMJDs. From
December 2005 through December 2007, NIH issued funding announcements
addressing 15 other research areas that explicitly noted that TMJDs
could be included as a research focus.[Footnote 31] The following
examples illustrate areas of research addressed in these targeted
funding announcements:[Footnote 32]
* In August 2006 and January 2007, NIH's National Institute of Nursing
Research, in collaboration with NIH's Pain Consortium, issued a set of
funding announcements entitled "Mechanisms, Models, Measurement, &
Management in Pain Research." These announcements indicated NIH's
interest in receiving applications through early September 2009 to
support a wide range of pain research, including basic and clinical
pain studies. TMJDs were among several pain conditions--such as
headaches, fibromyalgia, and spinal cord injury pain--that were
identified as being of special interest. These funding announcements
invited researchers to submit applications that could address TMJDs,
but did not require them to do so. The funding announcements issued for
this area of research were identical in scientific scope and also
involved three separate types of research activities--research project
grants, small research grants, and exploratory/developmental grants.
* In December 2005, NIDCR issued a set of funding announcements
entitled "Drug Delivery Systems for Orofacial Disease." These
announcements expressed interest in receiving applications for small
business innovation research grants and small business technology
transfer grants, which support research and development projects that
could result in commercial projects or services. The targeted funding
announcements indicated NIH's interest in supporting research on the
design and development of novel delivery systems for drugs to treat
oral diseases (such as tooth decay and periodontal disease) or TMJDs.
The announcements expire in May 2008.
In addition to signaling interest in supporting research in these
specific substantive areas, NIH has also encouraged institutions to
submit applications to support training programs that could address
TMJDs. NIH officials and representatives of advocacy groups told us
that the scientific workforce has not always included as many qualified
TMJD researchers as would be desirable. Although institutional training
grants are not designed to guarantee that individuals obtain training
as TMJD researchers, such grants can create opportunities to do so. NIH
issued a funding announcement in January 2006 entitled "Institutional
Grants for Research Training in Biomedical Informatics" that signaled
its interest in receiving applications through mid-March 2006 to fund
continuing-education training grants.[Footnote 33] These grants assist
professional schools and other public and nonprofit institutions to
establish, expand, or improve programs of continuing professional
education. This announcement explicitly mentioned that training in
TMJDs could be included as a specialized track offered through the
proposed training programs.
NIH officials also reported that they expect to issue additional
targeted funding announcements involving TMJDs as the agency identifies
appropriate areas for emphasis. In particular, agency officials told us
that they are exploring the merits of encouraging research that adopts
a systems approach to TMJDs. According to NIH officials, a systems
approach involves interdisciplinary research that explicitly seeks to
enhance the understanding of TMJDs by integrating information from
multiple domains, such as genetics, physiology, biochemistry, and
psychology. In September 2007, the Temporomandibular Muscle and Joint
Disorders Interagency Working Group participated in a meeting of a
Working Group of NIDCR's National Advisory Dental and Craniofacial
Research Council to discuss the systems approach to TMJDs and provide
guidance for the development of recommendations for the council's
consideration. NIH officials told us that as of February 2008, no
decisions had been reached about this issue.
NIH officials stressed that targeted funding announcements are a way
for NIH to signal interest in particular areas of research, and that
they plan to continue to support research investigating a broad range
of questions about TMJDs. They also emphasized that their future
support for research on TMJDs will continue to be driven by factors in
addition to their targeted funding announcements. In particular, most
future research on TMJDs is likely to be investigator-initiated and
will reflect the scientific developments that result from research that
is currently underway.
Agency Comments:
We provided a draft of this report to HHS for comment. The department
provided technical comments, which we incorporated as appropriate.
We are sending copies of this report to the Secretary of HHS, the
Director of NIH, relevant congressional committees, and interested
parties. We will also make copies available to others upon request. In
addition, this report will be available at no charge on GAO's Web site
at [hyperlink, http://www.gao.gov].
If you or your staff have any questions concerning this report, please
contact me at (202) 512-7114 or crossem@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this report. GAO staff who made major contributions to
this report are listed in enclosure IV.
Sincerely yours,
Signed by:
Marcia Crosse:
Director, Health Care:
[End of section]
Enclosures I:
Scope and Methodology:
To identify the research activities related to temporomandibular joint
and muscle disorders (TMJD) supported by the National Institutes of
Health (NIH) from fiscal years 2002 through 2006, we reviewed a list of
TMJD-related projects provided by NIH and interviewed NIH
officials.[Footnote 34] NIH prepared this list when developing its
estimate of funding for this set of disorders during these
years.[Footnote 35] Because we learned that some NIH institutes and
centers did not begin reporting TMJD-related projects until after
fiscal year 2002[Footnote 36] and that institutes and centers differed
in their methods for determining whether projects were TMJD-related, we
validated the list of projects NIH provided. In addition, we took steps
to determine whether NIH had sponsored other relevant projects that
were not included on its list.
To validate information on NIH's list and confirm that a project was
TMJD-related, we reviewed an abstract or other documentation, such as a
progress report, for each listed project. We also interviewed agency
officials about how NIH's institutes and centers determined which
projects were related to TMJDs. We did not develop independent criteria
for what constitutes TMJD-related research; instead, we relied on NIH's
scientific expertise. For example, research on pain mechanisms can be
directly or indirectly relevant to TMJDs, and we relied on NIH
officials to determine which of these projects to count. For each
listed project, we confirmed that the abstract or other documentation
either addressed TMJDs directly or addressed topics that we determined
had been among NIH's research priorities for TMJDs from fiscal years
2002 through 2006. These topics included the biomechanics of the jaw;
conditions that are comorbid with TMJDs (including irritable bowel
syndrome, chronic fatigue syndrome, fibromyalgia, multiple chemical
sensitivity, and sleep disorders); craniofacial or orofacial pain;
gender differences in TMJDs or pain; pain mechanisms and management;
reconstruction technologies related to the temporomandibular joint and
surrounding orofacial areas; risk factors for TMJDs; and the trigeminal
system (which involves the motor and sensory nerves for the mandibular
region). When our review of the abstracts or other documentation did
not readily confirm that a project was TMJD-related, we sought
clarification from NIH officials. In some of these cases, NIH officials
agreed that projects had been mistakenly listed as TMJD-related, and we
removed those projects from our list. As one example, a project that
NIH had originally listed as TMJD-related was designed to study tibial
muscular dystrophy. That project had been mistakenly included on NIH's
list because the abstract referred to tibial muscular dystrophy by the
acronym, TMD, which is also an acronym that can refer to
temporomandibular joint and muscle disorders.
In addition, we took steps to ensure that we identified relevant
projects that were not included on NIH's list. Specifically, we
compared its list to one that we developed through a keyword search of
the Department of Health and Human Services' Computer Retrieval of
Information on Scientific Projects (CRISP) database.[Footnote 37] We
searched for the keywords "temporomandibular," "TMD," and "TMJ" (which
would include TMJD).[Footnote 38] As we previously reported,[Footnote
39] however, and NIH officials confirmed, there are limits to the
reliability and validity of information derived from the CRISP
database. For example, CRISP abstracts are based on grant applications,
and not actual research activities. Researchers may revise their plans
after submitting an application. Thus, if a researcher initially
planned to include a study related to TMJDs as part of a broader
proposal, but eliminated that study from the research plan before NIH
funded it, the project could be incorrectly identified as TMJD-related
through a search of CRISP. When our search of CRISP identified projects
that were not on NIH's list of TMJD-related projects, we reviewed the
abstract. If the abstract appeared to be TMJD-related, we sought
clarification from NIH officials. In some of these cases, NIH officials
agreed that projects were TMJD-related, and so we added them to our
list. For example, one project had been omitted from the list because
the institute that funded the project did not consider TMJDs to be a
primary focus of the research. NIH officials agreed, however, that the
project was relevant to TMJDs, and we included it in our list.
Similarly, when NIH's list included a project that we had not
identified through our search of CRISP--as could happen when a
researcher who received funding to support research that was not
expected to address TMJDs subsequently conducted studies that were TMJD-
related--we resolved the discrepancy with NIH officials.
As another step to validate our list of TMJD-related projects, we
identified specific research projects that appeared on NIH's list as
TMJD-related during 1 or more fiscal years and, based on available
project documentation, appeared to have been underway during 1 or more
preceding fiscal years, but were not included on NIH's list as TMJD-
related during those years. We sought clarification from NIH for these
projects, and in some cases, NIH officials agreed that the project had
been mistakenly omitted from their list for 1 or more fiscal years. We
included those additional years of support in our list. As an example,
NIH's National Center for Research Resources (NCRR) had not previously
developed a list of TMJD-related projects for fiscal years 2003 or
2004. In response to our request for clarification about projects that
it listed for fiscal year 2005, but not for previous years, NCRR staff
reviewed their files for fiscal years 2002 through 2006. They then
provided us with a revised list of TMJD-related projects and supporting
documentation for each of those years. We adjusted our list of projects
accordingly.
It is possible that NIH supported research projects related to TMJDs
from fiscal years 2002 through 2006 that are not included in our final
list. Our search of CRISP would not identify all TMJD-related research
supported by NIH because the keywords we used to search CRISP would not
necessarily appear in each abstract. For example, research on the
biomechanics of the jaw could be of direct relevance to TMJDs, even if
the abstract or other information in CRISP did not include the keywords
"temporomandibular," "TMD," or "TMJ." If a TMJD-related project was not
on NIH's list of TMJD-related projects and the CRISP entry for a TMJD-
related project did not include the words "temporomandibular," "TMJ,"
or "TMD," then we would not have identified it. Based on these analyses
and discussions, we determined that our final list of TMJD-related
projects supported by NIH from fiscal years 2002 through 2006 was
sufficiently reliable and valid for our purposes.
To identify NIH's plans to support future research on TMJDs, we
reviewed public announcements of NIH research funding opportunities
issued from December 2005 through December 2007. We identified relevant
targeted funding announcements by searching NIH's online Guide for
Grants and Contracts[Footnote 40] for the keywords "temporomandibular,"
"TMD," "TMJ," and "TMJD."[Footnote 41] We asked NIH whether it had
funded TMJD-related research applications submitted in response to the
targeted funding announcements.[Footnote 42] We also interviewed NIH
officials about their plans to support future research on TMJDs,
including potential funding announcements. In addition, we interviewed
representatives of three TMJD advocacy groups to help us understand
their perspectives on TMJD-related research. These advocacy groups were
the American Alliance of TMD Organizations, the Jaw Joints & Allied
Musculo-Skeletal Disorders Foundation, and the TMJ Association.
We conducted this performance audit from February 2007 through March
2008 in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit
to obtain sufficient, appropriate evidence to provide a reasonable
basis for our findings and conclusions based on our audit objectives.
We believe that the evidence obtained provides a reasonable basis for
our findings and conclusions based on our audit objectives.
[End of section]
Enclosure II:
Research Projects Related to Temporomandibular Joint and Muscle
Disorders Supported by the National Institutes of Health:
We identified 170 projects related to temporomandibular joint and
muscle disorders (TMJD) funded by the National Institutes of Health
(NIH) from fiscal years 2002 through 2006. These projects were funded
or cofunded by two offices within the Office of the Director--the
Office of Research on Women's Health (ORWH) and the Office of Rare
Diseases (ORD)--and by the following NIH institutes and centers:
* National Center for Complementary and Alternative Medicine (NCCAM),
* National Center for Research Resources (NCRR),
* National Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS),
* National Institute of Biomedical Imaging and Bioengineering (NIBIB),
* National Institute of Child Health and Human Development (NICHD),
* National Institute of Dental and Craniofacial Research (NIDCR),
* National Institute of Mental Health (NIMH),
* National Institute of Neurological Disorders and Stroke (NINDS),
* National Institute on Deafness and Other Communication Disorders
(NIDCD), and:
* National Institute on Drug Abuse (NIDA).
These projects involved a variety of types of research activities.
Specifically, these projects included the following:
* extramural research projects, which are discrete, specified,
circumscribed projects performed by a particular investigator(s) in an
area representing the investigator's specific interest and competencies
(table 2);
* extramural centers and research program projects, which involve
multiple research activities or subprojects (table 3);[Footnote 43]
* extramural fellowships and research career program grants, which
support individuals as they obtain research training or pursue research
careers (table 4);
* extramural conferences, which are organized meetings where people
exchange information (table 5);
* other extramural research activities (table 6); and:
* intramural research projects (table 7).
Table 2: NIH-Supported Extramural Research Projects Related to TMJDs,
Fiscal Years 2002-2006:
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Fibromyalgia, Depression and Myofascial TMD.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Four Treatment Strategies for TMJ Disk Displacement.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Gonadal Steroid Hormonal Regulation of Persistent Pain.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Menstrual Cycle Effects on TMD Pain and Other Symptoms.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Nerve- Muscle Interactions during Jaw Muscle
Development.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Pain and Analgesic Response--Sex and Hormone Variations.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Parafunctional Activity and Temporomandibular Disorders.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Photopolymerization for Noninvasive Cartilage Tissue.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Puberty and Gender Differences in Pain Responsivity.
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Regulation of Masticatory Muscle Fiber Phenotype.
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Gender Differences in Pain Sensation and Pain Report.
Fiscal year(s): 2002-2003;
Primary funding institute or center: NICHD;
Cofunding institute, center, or office: None;
Project title: Neuronal Control of CGRP Gene Expression.
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Sex vs Gender in Pain Perception.
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Tissue Engineering of the Temporomandibular Joint.
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: An Evaluation and Treatment Study of TMD.
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Engineering Skeletal Muscle with Biodegradable
Hydrogels.
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Interaction Affecting Craniofacial Muscle
Differentiation and Morphogenesis.
Fiscal year(s): 2002-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Engineering Joint Scaffolds for Function/Regeneration.
Fiscal year(s): 2002-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Kinesthetic Mechanisms in the Trigeminal System.
Fiscal year(s): 2002-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Mechanisms of Persistent Temporomandibular Pain.
Fiscal year(s): 2002-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Pain Management in Temporomandibular Joint Disorders.
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Estrogen and Inflammation in TMD Pain.
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Mechanical Environment in Mandibular Distraction.
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Nanocrystalline Coatings for Dental TMJ Implants /
Nanotechnology in Osseointegration of TMJ Implants.
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: The Role of Tooth Mechanoreceptors in Jaw Movement.
Fiscal year(s): 2003-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Genotype and TMJD Vulnerability Traits.
Fiscal year(s): 2003-2005;
Primary funding institute or center: NIBIB;
Cofunding institute, center, or office: None;
Project title: Novel Amino Acid-Based Glass-Ionomer Biomaterials.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIBIB;
Cofunding institute, center, or office: None;
Project title: Biomaterials (Mg/Zn/F-BCPs) for Osteoporosis Therapy.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Bone Growth, Periosteal Migration and Muscle Function.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Brainstem Mechanisms Controlling Jaw Movements.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Brief Focused Treatment for TMD: Mechanisms of Action.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: CGRP Control in Trigeminal Neurons in Vitro and in Vivo.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Cytokine Pathways and Orofacial Pain.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Estrogenic Regulation of Inflammation Related to TMJD.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Inflammation of TMJDs: Role of Biomechanical Signals.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NINDS;
Cofunding institute, center, or office: None;
Project title: Inflammation-Induced Plasticity in Sensory Neurons.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIBIB;
Cofunding institute, center, or office: None;
Project title: Injectable Osteoinductive Biodegradable Composities.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Integrins and Mechanoreception in the Inflamed TMJ.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Neuronal Plasticity Related to TMD and Fibromyalgia.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Peripheral NMDA Receptors and TMD Pain Mechanisms.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: RAGE, Inflammation and Temporomandibular Joint
Disorders.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Regulation of Mandibular Condylar Cartilage Growth.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Stem Cell- Driven Regeneration of the Mandibular Joint.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Trigeminal Pain Pathways.
Fiscal year(s): 2004-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Hormonal Cycles in Women: Effects on TMD Pain &
Symptoms.
Fiscal year(s): 2004-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: TMJ Disc Regeneration.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: COMT and AR Polymorphism and Development of Painful TMD.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Craniofacial Tissue Engineering.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIBIB;
Cofunding institute, center, or office: None;
Project title: Integrin- Specific Implant Surfaces for Bone Repair.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Optimizing Mandibular Scaffold Modulus/Porosity Balance.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Peripheral Receptor Mechanisms in Orofacial Muscle Pain.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Sex Steroids, and TMJ Pain.
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: CGRP Regulation of iNOS and MAP Kinases/Phosphatases in
Trigeminal Ganglia Glia.
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Effects of Gender and TMD on Mandibular Mechanics.
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Neuron- Glia Interactions in Trigeminal Ganglia as a
Basis for Future Therapy.
Source: GAO analysis of data from NIH.
Note: The extramural research project grants listed in this table are
known as R01 grants. (NIH identifies types of projects using a specific
letter, generally followed by a two-digit number.) Each such grant is
made to support a discrete, specified, circumscribed project to be
performed by a particular investigator(s) in an area representing the
investigator's specific interest and competencies. Some of these
projects are scheduled to end after fiscal year 2006.
[End of table]
Table 3: NIH-Supported Extramural Centers and Research Program Projects
Related to TMJDs, Fiscal Years 2002-2006:
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: EEG Studies of Vibrotactile Adaptation;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Effects of Dextromethorphan, Naloxone and Fentanyl on
Experimental Pain Stimuli;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: HPA Axis Dysregulation in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Investigate the Safety & Efficacy of LY293558 in
Patients with Chronic Neuropathic Pain;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Investigate the Safety / Efficacy of LY293558 in
Patients with Chronic Neuropathic Pain;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Mechanisms of Action in TMD Treatment;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NIAMS;
Cofunding institute, center, or office: None;
Project title: Multipurpose Arthritis and Musculoskeletal Diseases
Center;
Type of grant: Comprehensive center[C].
Fiscal year(s): 2002;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Neuroendocrinology of Masticatory Muscle Disorders in
Women;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Pain Sensitivity and the Development of
Temporomandibular Disorders;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Self Care Intervention for TMD;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Somatosensory Channel Interactions in Trigeminal Nerve-
Injured Patients;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Vibratory Analgesia in Normals and Persons with
Temporomandibular Disorders;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Chronic Pain Management in Primary Care;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCCAM;
Cofunding institute, center, or office: None;
Project title: Craniofacial Complementary & Alternative Medicine
Center;
Type of grant: Specialized center[D].
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Influence of Belief and Coping on TMD Pain Problems;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Interactions between the HPA Axis and ANS in Women with
Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Mechanisms in Chronic Multisymptom Illnesses;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Modification of Tonic and Experimental Pain in
Fibromyalgia Syndrome;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Pain in Adolescents: Biologic/Psychosocial Risk Factors;
Type of grant: Research program project[A] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Pain Perception in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Pilot Study of Acupuncture in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Regulation of Adrenal Function in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Role of Female Reproductive Hormones in TMJ Disease;
Type of grant: Comprehensive center[C] (subproject).
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Stress, Adrenergic and Inflammatory Factors in 4
Disorders;
Type of grant: Comprehensive center[C] (subproject).
Fiscal year(s): 2002-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Genetic Fibromyalgia Study;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Immunoneuroendocrine Response to Tetanus Toxoid;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Mapping of Genes for Fibromyalgia Syndrome;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Factors in Arthritis, CFS, Fibromyalgia &
Temporomandibular Disorders;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Physiological Benefits of Psychological Well-Being in
Chronic Disease;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: The Role of Female Reproductive Hormones in the
Etiopathogenesis of TMJ Diseases;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Fibromyalgia: Central Factors in Its Etiopathogenesis--
Second Cycle;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Neuroendocrine Alterations in Fibromyalgia and IBS;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIAMS;
Cofunding institute, center, or office: ORWH;
Project title: ORWH: SCOR on Sex and Gender Factors Affecting Women's
Health;
Type of grant: Specialized center[D].
Fiscal year(s): 2002-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Sex- Related Determinants of Pain Responses in
Fibromyalgia and Temporomandibular Disorders / Sex-Related Determinants
of Pain Responses in Fibromyalgia-Family Study;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2003-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Autonomic Arousal and Abnormal Pain Sensitivity in
Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2003-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Cerebrospinal Fluid Neuropeptides in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2003-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Effect of Analgesics on Experimental Pain;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2003-2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Optimizing Fibromyalgia Self Management;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2003-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Mapping Genes for Fibromyalgia Syndrome;
Type of grant: Biotechnology resource grant[E] (subproject).
Fiscal year(s): 2003-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Pain Management in Temporomandibular Joint Disorders;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2003-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Sensory Testing in Patients with Chronic Musculoskeletal
Pain Syndromes;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Real-Time fMRI Directed Modulation of Pain Perception
and Brain Activation in Chronic Pain;
Type of grant: Biotechnology resource grant[E] (subproject).
Fiscal year(s): 2004-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Beneficial Exercise and Diet Effects in Fibromyalgia
with Pyridostigmine;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Evaluation of Sleep Dysfunction in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Functional MRI Study of Cognition in Patients with Lupus
and Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004-2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Testing for Single Nucleotide Polymorphisms Associated
with Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Brief Focused Treatment for TMD: Mechanisms of Action;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004-2006;
Primary funding institute or center: NINDS;
Cofunding institute, center, or office: None;
Project title: CNS Processes Underlying Pain Regulation and
Persistence;
Type of grant: Research program project[A].
Fiscal year(s): 2004-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Long-Term FMS Self-Management;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2004-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Subject Registry: Interdisciplinary Studies of Chronic
Multi-Symptom Illnesses;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Cardiovascular Disease Risk in Young Rheumatoid
Arthritis Patients;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2005;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: University of Kentucky Center of Biomedical Research
Excellence: Pilot Projects;
Type of grant: Exploratory grant[F] (subproject).
Fiscal year(s): 2005-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Effectiveness of EEG Biofeedback in the Treatment of
Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2005-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Pain Mechanisms in Chronic Multi-Symptom Illnesses;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2005-2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Peripheral and Central Sensitization after Eccentric
Muscle Exercise;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: GHRH Perturbations in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Immunological and Genetic Analysis of Autoinflammatory
Genes in Fibromyalgia;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Locus of Pain Control: Neural Substrates and
Modifability;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Mechanisms of Acupuncture Analgesia: A (fMRI) and (PET)
Study;
Type of grant: General clinical research center[B] (subproject).
Fiscal year(s): 2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Sleep Disturbance and Pain Sensitivity in Chronic Pain;
Type of grant: General clinical research center[B] (subproject).
Source: GAO analysis of data from NIH.
Notes: Grants for general clinical research centers are known as M01
grants; research program projects and centers are in NIH's category of
P grants. (NIH identifies types of projects using a specific letter,
generally followed by a two-digit number.) These grants support
multiple research activities or subprojects. NCRR and NIDCR reported
these grants at the subproject level; NCCAM, NIAMS, and NINDS reported
them at the overall center level. Some of these projects are scheduled
to end after fiscal year 2006.
[A] A research program project grant is designed to support a broadly
based, multidisiciplary program that has a specific major objective or
basic theme and generally involves the organized efforts of several
investigators conducting related research projects.
[B] A general clinical research center grant is designed to support a
discrete research unit within a hospital or other inpatient care
facility where scientists conduct studies on a wide range of issues.
Covered costs include operational costs, such as equipment, and
supplies.
[C] A comprehensive center grant is designed to bring together related
facilities within a specific community to achieve such goals as
fostering research and educating professionals about specific
disorders.
[D] A specialized center grant is designed to support multidisciplinary
research, both basic and clinical, on a specific disorder or biomedical
issue.
[E] A biotechnology research grant is designed to make biotechnological
resources available to multiple qualified investigators.
[F] An exploratory grant for a research program project or center is
designed to support planning for new programs, expansion or
modification of existing resources, or studies of the feasibility of
interdisciplinary programs.
[End of table]
Table 4: NIH-Supported Extramural Fellowships and Research Career
Program Grants Related to TMJDs, Fiscal Years 2002-2006:
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Individual Predoctoral Dental Scientist Fellowship;
Type of grant: NIDCR individual predoctoral dental scientist
fellowship[A].
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIMH;
Cofunding institute, center, or office: None;
Project title: Early Detection and Prevention of Chronic Pain
Disability;
Type of grant: Research scientist development award--Research[B].
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Individual Predoctoral Dental Scientist Fellowship;
Type of grant: NIDCR individual predoctoral dental scientist
fellowship[A].
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Modulation of TMJ Degradation by Relaxin and Estrogen;
Type of grant: Research scientist development award--Research[B].
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Tissue Engineering of Temporomandibular Joint Cartilage;
Type of grant: Career transition award[C].
Fiscal year(s): 2002-2006;
Primary funding institute or center: NINDS;
Cofunding institute, center, or office: None;
Project title: Spatial and Temporal Characteristics of Central
Sensitization in Chronic Pain Diseases;
Type of grant: Mentored patient-oriented research career development
award[D].
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Brainstem Mechanisms of Craniofacial Muscle Pain;
Type of grant: Career transition award[C].
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Molecular Targeting of the Vanilloid-1 Receptor;
Type of grant: Career transition award[C].
Fiscal year(s): 2004-2006;
Primary funding institute or center: NIMH;
Cofunding institute, center, or office: None;
Project title: Comorbidity of Mental Disorders and Pain;
Type of grant: Research scientist award[E].
Fiscal year(s): 2004-2006;
Primary funding institute or center: NINDS;
Cofunding institute, center, or office: None;
Project title: Sleep Disturbance and Pain Sensitivity in Chronic Pain;
Type of grant: Mentored patient-oriented research career development
award[D].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Individual Predoctoral Dental Scientist Fellowship;
Type of grant: NIDCR individual predoctoral dental scientist
fellowship[A].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Innovative Minimal Contact Therapy for Reducing TMD
Pain;
Type of grant: Postdoctoral individual National Research Service
award[F].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Mechanical Stimulation of Cells in Photopolymerized
Gels;
Type of grant: Career transition award[C].
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Individual Predoctoral Dental Scientist Fellowship;
Type of grant: NIDCR individual predoctoral dental scientist
fellowship[A].
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Regulation of Genes in Mouse Temporomandibular Joint;
Type of grant: Career transition award[C].
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Accelerated Osteoarthritis in the TMJ of
Biglycan/Fibromodilin DKO Mice;
Type of grant: Career transition award[C].
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Central Pain Processing in Chronic Face Pain: fMRI
Study;
Type of grant: Mentored patient-oriented research career development
award[D].
Source: GAO analysis of data from NIH.
Notes: Extramural fellowship and research career program grants are in
NIH's F and K categories of grants. (NIH identifies types of projects
using a specific letter, generally followed by a two-digit number.)
Some of these projects are scheduled to end after fiscal year 2006. In
addition to the grants listed in this table, NIDCR funded three dentist
scientist award grants to institutions to support programs designed to
allow newly trained dentists, who were appointed by the institution, to
develop independent research skills. These grants could have supported
TMJD-related research, but were not necessarily used for such research
and therefore are not listed.
[A] An NIDCR individual predoctoral dental scientist fellowship is
designed to support integrated dental and graduate research training
that leads to attainment of both a Doctor of Dental Surgery or Doctor
of Dental Medicine degree and a Doctor of Philosophy degree.
[B] A research scientist development award for research is designed to
support a researcher who needs additional experience to pursue a
commitment to research.
[C] A career transition award is designed to support newly trained
investigators by facilitating establishment of a record of independent
research to sustain or promote a successful research career.
[D] A mentored patient-oriented research career development award is
designed to support supervised study and research for clinically
trained professionals who have the potential to develop into
productive, clinical investigators focusing on patient-oriented
research.
[E] A research scientist award is designed to support a research
scientist who is qualified to pursue independent research that would
extend the research program of that researcher's institution or direct
an essential part of that research program.
[F] A postdoctoral individual National Research Service award is
designed to support individuals who have completed doctoral training as
they broaden their scientific background and extend their potential for
research.
[End of table]
Table 5: NIH-Supported Extramural Conferences Related to TMJDs, Fiscal
Years 2002-2006:
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: NIAMS, NIBIB;
Project title: Joint and Muscle Dysfunction of Temporomandibular Joint.
Fiscal year(s): 2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: NIAMS, NIBIB, ORWH, ORD;
Project title: Advancing Diagnostic Approaches for TMJ Disorders.
Fiscal year(s): 2004, 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Craniofacial Skeletal Tissue Engineering Conference.
Fiscal year(s): 2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: ECM in Structure & Function of the Craniofacial Complex.
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: NIBIB;
Project title: TMJ Bioengineering Conference.
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: NIAMS, NIDA, NIDCD, NINDS,
ORWH;
Project title: A Systems Approach to the Understanding of TMJ as a
Complex Disease.
Source: GAO analysis of data from NIH.
Note: Conferences are funded as R13 grants, which support organized
meetings where people exchange information. (NIH identifies types of
projects using a specific letter, generally followed by a two-digit
number.) Some of these projects are scheduled to end after fiscal year
2006.
[End of table]
Table 6: Other NIH-Supported Extramural Research Projects Related to
TMJDs, Fiscal Years 2002-2006:
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Cellular and Molecular Targeting of TMJ Destruction;
Type of grant or other support: Small research grant[A].
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: K-Opioid Systems--Sex and Pregnancy Linked Differences;
Type of grant or other support: First independent research support and
transition award[B].
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Animal Models for TMJ Research: Functional 3-D Loading;
Type of grant or other support: Small research grant[A].
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: DentoCAT: Dentomaxillofacial CT Scanner;
Type of grant or other support: Small business innovation research
grant--phase II[C].
Fiscal year(s): 2002-2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Mechanical Stimulation for TMJ Disc Tissue Engineering;
Type of grant or other support: Small research grant[A].
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIDCR[D];
Cofunding institute, center, or office: NIBIB, ORWH;
Project title: NIDCR TMJ Implant Registry and Repository;
Type of grant or other support: Research and development contract[E].
Fiscal year(s): 2002-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Research Diagnostic Criteria--Reliability and Validity;
Type of grant or other support: Research project (cooperative
agreement)[F].
Fiscal year(s): 2003;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: A 3-D Interactive Atlas of the Human Mandible and TMJ;
Type of grant or other support: Small business innovation research
grant--phase I[G].
Fiscal year(s): 2003-2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: A New Nanocomposite Scaffold for TMJ Tissue Engineering;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2003-2004;
Primary funding institute or center: NIBIB;
Cofunding institute, center, or office: None;
Project title: Molecular Imprinting to Control Cell Responses;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2003-2004;
Primary funding institute or center: NIDA;
Cofunding institute, center, or office: None;
Project title: Recombinant Herpes Injection into Trigeminal Ganglia;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2003-2004;
Primary funding institute or center: NCCAM;
Cofunding institute, center, or office: None;
Project title: Shamanic Healing for Women with TMD;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2004;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: Digitized Transmission Electron Microscope:
Temporomandibular Disorders;
Type of grant or other support: Biomedical research support shared
instrumentation grant[I].
Fiscal year(s): 2004;
Primary funding institute or center: NIBIB;
Cofunding institute, center, or office: None;
Project title: Incorporating Bone Minerals into Orthopaedic Surfaces;
Type of grant or other support: Small business technology transfer
grant--phase I[J].
Fiscal year(s): 2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Neural Substrates of Adaptive Jaw Movement;
Type of grant or other support: Academic research enhancement award[K].
Fiscal year(s): 2004;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Polymer Gel to Treat TMJ Pain;
Type of grant or other support: Small business innovation research
grant--phase I[G].
Fiscal year(s): 2004-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: ORWH;
Project title: Mast Cell Role in Masseter Muscle Repair;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2004-2005;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Temporomandibular Joint Syndrome in Females;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2004-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: A 3-D Interactive Atlas of the Maxilla, Mandible & TMJ;
Type of grant or other support: Small business innovation research
grant--phase II[C].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Mandibular Bone Transport Reconstruction Plate;
Type of grant or other support: Small business technology transfer
grant--phase II[L].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Mechanotransduction in Mandibular Tissue Engineering;
Type of grant or other support: Small research grant[A].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Neural Mechanisms of Chronic Muscle Pain Disorders;
Type of grant or other support: Small research grant[A].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Orofacial Pain: Prospective Evaluation and Risk
Assessment[M];
Type of grant or other support: Research project (cooperative
agreement)[F].
Fiscal year(s): 2005-2006;
Primary funding institute or center: NCCAM;
Cofunding institute, center, or office: None;
Project title: TCM for TMD: A Multi-Site Whole Systems Trial;
Type of grant or other support: Research project (cooperative
agreement)[F].
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: A Novel Model of TMJ Osteoarthritis to Define Glial
Reactivity in Chronic Pain;
Type of grant or other support: Exploratory/developmental grant[H].
Fiscal year(s): 2006;
Primary funding institute or center: NCRR;
Cofunding institute, center, or office: None;
Project title: ICP-MS Instrument for Baylor College of Dentistry;
Type of grant or other support: Biomedical research support shared
instrumentation grant[I].
Fiscal year(s): 2006;
Primary funding institute or center: NIDCR;
Cofunding institute, center, or office: None;
Project title: Joint Degeneration: Somatic Mosaic Analysis in a
Transgenic Mouse;
Type of grant or other support: Exploratory/developmental grant[H].
Source: GAO analysis of data from NIH.
Notes: Biomedical research support shared instrumentation grants are
known as S10 grants, research and development contracts are designated
by N01, and research projects (cooperative agreements) are designated
by U01. The remaining projects listed in this table are funded under
NIH's R grant programs. (NIH identifies types of projects--including
grants, cooperative agreements, and contracts--using a specific letter,
generally followed by a two-digit number.) Some of these projects are
scheduled to end after fiscal year 2006.
[A] Small research grants are designed to support research that can be
carried out in a short period of time with limited resources.
[B] First independent research support and transition awards were
designed to support newly independent investigators as they initiated
their own research and demonstrated the merit of their own research
ideas. NIH stopped accepting applications for these awards in 1998.
[C] Small business innovation research grants--phase II are designed to
support in-depth development of research and development concepts that
have been shown to be feasible in a prior phase of funding.
[D] NIDCR did not provide funding for this project in fiscal year 2004.
[E] Research and development contracts support research-related
activities conducted under contract to NIH.
[F] Research projects (cooperative agreements) support a discrete,
specified, circumscribed project to be performed by a particular
investigator(s) in an area representing the investigator's specific
interest and competencies, with the anticipation that NIH staff will
have a substantial programmatic involvement in the project.
[G] Small business innovation research grants--phase I are designed to
support time-and resource-limited research to establish the technical
merit and feasibility of research and development concepts that could
lead to commercial products or services.
[H] Exploratory/developmental grants are designed to encourage the
development of new research activities by supporting the early and
conceptual stages of their development.
[I] Biomedical research support shared instrumentation grants are
designed to make research instruments available to multiple NIH-
supported researchers at the same institution.
[J] Small business technology transfer grants--phase I are designed to
support time-and resource-limited research by small businesses in
cooperation with research institutions to establish the technical merit
and feasibility of ideas that have potential for commercialization.
[K] Academic research enhancement awards are designed to support small-
scale research projects conducted by faculty in institutions that grant
primarily baccalaureate degrees.
[L] Small business technology transfer grants--phase II are designed to
support in-depth, time-and resource-limited research by small
businesses in cooperation with research institutions on ideas that have
potential for commercialization and have been shown to be feasible in a
prior phase of funding.
[M] This project was initially entitled "Risk Factors for Onset and
Persistence of TMD."
[End of table]
Table 7: NIH-Supported Intramural Research Projects Related to TMJDs,
Fiscal Years 2002-2006:
Fiscal year(s): 2002;
Primary funding institute or center: NIDCR;
Project title: Clinical Investigations in Infectious & Autoimmune
Diseases.
Fiscal year(s): 2002-2004;
Primary funding institute or center: NIDCR;
Project title: Experimental Therapeutics for Chronic Orofacial Pain.
Fiscal year(s): 2003-2006;
Primary funding institute or center: NIDCR;
Project title: Analgesic Mechanisms in Patients with Chronic Pain.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Project title: Function of Skeletal Matrix Genes.
Fiscal year(s): 2005-2006;
Primary funding institute or center: NIDCR;
Project title: Genetic Studies of Human Craniofacial Diseases.
Source: GAO analysis of data from NIH.
Note: Scientists in NIH Intramural Research Programs are generally
responsible for conducting original research consonant with the goals
of their individual institute or center. Intramural research projects
are coded as Z01 projects. (NIH identifies types of projects using a
specific letter, generally followed by a two-digit number.)
[End of table]
[End of section]
Enclosure III:
Areas of Research Addressed in Targeted Funding Announcements Involving
Temporomandibular Joint and Muscle Disorders Issued by the National
Institutes of Health:
From December 2005 through December 2007, the National Institutes of
Health (NIH) released targeted funding announcements--public
announcements that describe opportunities for NIH funding--for research
in areas that either focused directly on temporomandibular joint and
muscle disorders (TMJD) or addressed other areas, such as pain, that
could include TMJDs. These targeted funding announcements were issued
by the following NIH institutes and offices:
* National Cancer Institute (NCI),
* National Institute of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS),
* National Institute of Biomedical Imaging and Bioengineering (NIBIB),
* National Institute of Dental and Craniofacial Research (NIDCR),
* National Institute of Neurological Disorders and Stroke (NINDS),
* National Institute of Nursing Research (NINR),
* National Institute on Deafness and Other Communication Disorders
(NIDCD), and:
* Office of Behavioral and Social Sciences Research (OBSSR) and the
Office of Research on Women's Health (ORWH), both within NIH's Office
of the Director.
Specifically, NIH released targeted funding announcements from December
2005 through December 2007 covering one area of research that was
directly focused on TMJDs--the co-occurrence of TMJDs with other
chronic conditions such as chronic fatigue syndrome. During the same 2-
year time period, NIH issued targeted funding announcements addressing
15 other areas of research, such as pain, that identified TMJDs as a
possible--but not required--research topic.[Footnote 44] (See table 8
for a list of the 16 areas of research addressed by these targeted
funding announcements.)
Table 8: Areas of Research Addressed in NIH's Targeted Funding
Announcements Involving TMJDs:
Area of research[A]: Temporomandibular Joint and Muscle Disorders:
Pathophysiological Mechanisms Linking Comorbid Conditions;
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 3/24/2006;
12/13/2006[D];
Expiration date: 5/8/2009;
Type of grant(s)[C]: Research project grant;[E] small research grant;f
exploratory/developmental grantg;
Focus of proposed research: Must involve TMJDs.
Area of research[A]: Developing Complex Models of Oral Health
Behavior[H];
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 12/26/2007;
Expiration date: 11/15/2008;
Type of grant(s)[C]: Exploratory/developmental grant[G];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Collaborative Research on Tinnitus[H];
Issuing institute, center, or office[B]: NIDCD;
Publication date(s): 8/24/2007;
Expiration date: 10/23/2007;
Type of grant(s)[C]: Research project grant[E];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Application of Metabolomics for Translational and
Biological Research;
Issuing institute, center, or office[B]: NCI;
Publication date(s): 1/17/2007;
Expiration date: 1/8/2010;
Type of grant(s)[C]: Research project grant;[E]
exploratory/developmental grantg;
Focus of proposed research: May involve TMJDs.
Area of research[A]: Mechanisms, Models, Measurement, & Management in
Pain Research;
Issuing institute, center, or office[B]: NINR;
Publication date(s): 8/31/2006;
1/8/2007[D];
Expiration date: 9/8/ 2009;
Type of grant(s)[C]: Research project grant;[E] small research grant;f
exploratory/developmental grantg;
Focus of proposed research: May involve TMJDs.
Area of research[A]: Chronic Fatigue Syndrome: Pathophysiology and
Treatment;
Issuing institute, center, or office[B]: ORWH;
Publication date(s): 12/22/2006;
Expiration date: 11/6/2007;
11/17/2007[I];
Type of grant(s)[C]: Research project grant;[E] small research grant;f
exploratory/developmental grantg;
Focus of proposed research: May involve TMJDs.
Area of research[A]: Epidemiological and Behavioral Research in Oral
Health;
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 12/14/2006;
Expiration date: 1/8/2010;
Type of grant(s)[C]: Research project grant[E];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Research on Mind-Body Interactions and Health;
Issuing institute, center, or office[B]: OBSSR;
Publication date(s): 11/21/2006;
Expiration date: 1/8/2010;
Type of grant(s)[C]: Research project grant[E];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Enabling Technologies for Tissue Engineering and
Regenerative Medicine;
Issuing institute, center, or office[B]: NIBIB;
Publication date(s): 8/1/2006;
Expiration date: 5/21/2009;
Type of grant(s)[C]: Research project grant[E];
Focus of proposed research: May involve TMJDs.
Area of research[A]: New Models of Pain Relevant to the Trigeminal
System[H];
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 5/17/2006;
7/14/2006[I];
Expiration date: 11/22/2006;
Type of grant(s)[C]: Research project grant;[E]
exploratory/developmental grantg;
Focus of proposed research: May involve TMJDs.
Area of research[A]: Specialized Centers Of Interdisciplinary Research
(SCOR) On Sex And Gender Factors Affecting Women's Health[H];
Issuing institute, center, or office[B]: NIAMS;
Publication date(s): 6/12/2006;
Expiration date: 9/15/2006;
Type of grant(s)[C]: Specialized center grant[J];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Joint Degeneration: Mouse Models;
Issuing institute, center, or office[B]: NIAMS;
Publication date(s): 6/9/2006;
Expiration date: 1/8/2008;
Type of grant(s)[C]: Exploratory/ developmental grant[G];
Focus of proposed research: May involve TMJDs.
Area of research[A]: NIDCR Clinical Trial Planning Grant;
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 3/17/2006;
Expiration date: 1/8/2009;
Type of grant(s)[C]: Exploratory/ developmental grant[G];
Focus of proposed research: May involve TMJDs.
Area of research[A]: International Collaborative Oral Health Research
Planning Grant;
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 3/8/2006;
Expiration date: 1/8/2009;
Type of grant(s)[C]: Exploratory/developmental grant[G];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Neurobiology Of Persistent Pain Mediated By The
Trigeminal Nerve;
Issuing institute, center, or office[B]: NINDS;
Publication date(s): 3/3/2006;
Expiration date: 7/1/2006;
Type of grant(s)[C]: Exploratory/developmental grant[G];
Focus of proposed research: May involve TMJDs.
Area of research[A]: Drug Delivery Systems for Orofacial Disease;
Issuing institute, center, or office[B]: NIDCR;
Publication date(s): 12/13/2005;
Expiration date: 5/8/2008;
Type of grant(s)[C]: Small business technology transfer grant--phase I
and II;[K];
Small business innovation research grant--phase I and II[L];
Focus of proposed research: May involve TMJDs.
Source: GAO analysis of NIH data.
Notes: This table includes areas of research addressed in targeted
funding announcements--program announcements or requests for
applications--released from December 2005 through December 2007.
Program announcements describe areas of research that NIH is interested
in funding, but for which it has generally not set funds aside.
Requests for applications describe areas of research for which NIH has
set funds aside. No requests for proposals (solicitations for contract
proposals) issued during this time frame involved TMJDs. If an
announcement was reissued during this time period, we listed the most
recent announcement. Expired announcements were included in recognition
of the lag time between receipt of an application submitted to NIH in
response to a funding announcement and funding decisions reached by
NIH.
[A] Funding announcements with the same title and scientific scope are
grouped together as one area of research. We defined the area of
research by the title of the funding announcement(s).
[B] We have listed the issuing organization identified in NIH's online
Guide for Grants and Contracts.
[C] In general, NIH issued a separate funding announcement for each
type of grant listed.
[D] The later date applies to the funding announcement for the research
project only.
[E] Research project grants support discrete, specified, circumscribed
projects to be performed by a particular investigator(s) in an area
representing the investigator's specific interest and competencies.
[F] Small research grants are designed to support research that can be
carried out in a short period of time with limited resources.
[G] Exploratory/developmental grants are designed to encourage the
development of new research activities by supporting the early and
conceptual stages of their development.
[H] The funding announcements for this area of research were requests
for applications. All other funding announcements listed in the table
were program announcements.
[I] The earlier date applies to the funding announcement for research
project grants only. NIH officials told us that the announcement
entitled "Chronic Fatigue Syndrome: Pathophysiology and Treatment" that
had an expiration date of 11/17/2007 has remained active and will be
replaced through an arrangement with the Office of Extramural Research.
[J] A specialized center grant is designed to support multidisciplinary
research, both basic and clinical, on a specific disorder or biomedical
issue.
[K] Small business technology transfer grants--phase I are designed to
support time-and resource-limited research by small businesses in
cooperation with research institutions to establish the technical merit
and feasibility of ideas that have potential for commercialization.
Phase II grants are designed to support in-depth, time-and resource-
limited research by small businesses in cooperation with research
institutions on ideas that have potential for commercialization and
have been shown to be feasible in a prior phase of funding.
[L] Small business innovation research grants--phase I are designed to
support time-and resource-limited research to establish the technical
merit and feasibility of research and development concepts that could
lead to commercial products or services. Phase II grants are designed
to support in-depth development of research and development concepts
that have been shown to be feasible in a prior phase of funding.
[End of table]
[End of section]
Enclosure IV:
GAO Contact and Staff Acknowledgments:
GAO Contact:
Marcia Crosse, (202) 512-7114 or crossem@gao.gov:
Acknowledgments:
In addition to the contact named above, Geraldine Redican-Bigott,
Assistant Director; Kristen Joan Anderson; Laura Sutton Elsberg;
Cathleen Hamann; and Julian Klazkin made key contributions to this
report.
[End of section]
Footnotes:
[1] In this report, we use the acronym TMJDs to be consistent with the
terminology preferred for this set of conditions by the National
Institutes of Health (NIH). Other common acronyms include TMJ and TMD.
[2] Although NIH previously reported that TMJDs may affect as many as
10 million Americans, this estimate is based on papers presented at the
Technology Assessment Conference on TMJDs in 1996. NIH officials told
us that additional epidemiological research is needed to validate the
number of Americans affected by TMJDs.
[3] Artificial temporomandibular joint implants have been used to
replace the jaw joint in an effort to decrease pain and increase jaw
function for some individuals in this latter group. Experts recommend
that conservative treatments be used to relieve symptoms before
irreversible treatments--such as implants--are used. Conservative
treatments can include taking pain medications, using a splint or bite
guard, applying ice packs, or eating soft food. See GAO, Medical
Devices: FDA's Approval of Four Temporomandibular Joint Implants, GAO-
07-996 (Washington, D.C.: Sept. 17, 2007).
[4] Management of Temporomandibular Disorders: National Institutes of
Health Technology Assessment Conference Statement April 29-May 1, 1996
(Bethesda, Md.: U.S. Department of Health and Human Services, National
Institutes of Health, 1996).
[5] Applied research involves systematic study to gain the knowledge or
understanding necessary to determine the means by which a recognized
and specific need may be met. Applied research that addresses clinical
issues (such as the diagnosis or treatment of disease) is often
referred to as clinical research. Basic research involves systematic
study directed toward fuller knowledge or understanding of the
fundamental aspects of phenomena and of observable facts without
specific applications towards processes or products in mind. Basic
research may, however, include activities with the potential for broad
applications.
[6] Biomechanics refer to the mechanical bases of biological,
especially muscular, activity and the study of the principles and
relations involved. Research on the biomechanics of TMJDs could
include, for example, research on jaw movement or jaw muscle
development.
[7] When we did our work, fiscal year 2006 was the most recent year for
which NIH could provide full information about the TMJD-related
projects it funded.
[8] See [hyperlink, http://grants.nih.gov/grants/guide/index.html]
(accessed on Jan. 16, 2008).
[9] NIH's reported obligations are based on information provided by its
institutes and centers. These institutes and centers currently use
different procedures to determine whether a project is TMJD-related.
The institutes and centers also estimate how much of the total
obligation for the project to designate as TMJD-related based on
scientific judgments about the project. These estimated obligations do
not necessarily represent the exact obligations, nor do they
necessarily represent actual spending or costs. For example, reported
obligations may be greater than actual spending on TMJD-related
research if institutes or centers designated a high proportion of the
total amount obligated to a project as TMJD-related and only a small
proportion of the project's actual costs were TMJD-related. Reported
obligations may be lower than actual spending if institutes or centers
did not identify all TMJD-related projects, or did not include projects
of peripheral relevance to TMJDs. NIH officials stated that the process
of determining which projects are sufficiently related to TMJDs and
which are not is complex and involves scientific judgment. For example,
much of NIH's extensive portfolio of basic research on pain is
potentially relevant to TMJDs, and NIH did not classify all of its
basic pain research as TMJD-related. NIH is developing a new process
for classifying its research by disease or condition, including TMJDs,
that is expected to be implemented in phases by all institutes and
centers beginning with fiscal year 2008 data. NIH expects this system
to result in greater consistency across institutes and centers in
estimates of obligations, including TMJD-related estimates.
[10] See, for example, L. A. Aaron, M. M. Burke, and D. Buchwald,
"Overlapping Conditions Among Patients With Chronic Fatigue Syndrome,
Fibromyalgia, and Temporomandibular Disorder," Archives of Internal
Medicine, vol. 160 (2000).
[11] See, for example, T. T. Dao, K. Knight, and V. Ton-That,
"Modulation of Myofascial Pain by the Reproductive Hormones: A
Preliminary Report," Journal of Prosthetic Dentistry, vol. 79, no. 6
(1998); M. P. Warren and J. L. Fried, "Temporomandibular Disorders and
Hormones in Women," Cells, Tissues, Organs, vol. 169, no. 3 (2001); and
N. Landi, I. Lombardi, D. Manfredini, E. Casarosa, K. Biondi, M.
Gabbanini, and M. Bosco, "Sexual Hormone Serum Levels and
Temporomandibular Disorders: A Preliminary Study," Gynecological
Endocrinology, vol. 20, no. 2 (2005).
[12] NIH awards a cooperative agreement rather than a grant when it
anticipates that there will be substantial scientific or programmatic
involvement of NIH staff after funds are awarded. Substantial
involvement means that, after the cooperative agreement is awarded,
scientific or program staff will assist, guide, coordinate, or
participate in project activities. In contrast to grants and
cooperative agreements, which support research plans developed by
extramural investigators, NIH research and development contracts are
awarded to academic institutions and other nonprofit and commercial
organizations to procure specific activities for scientific inquiries
in particular areas of research and development needed by NIH.
[13] The remaining 6 percent of NIH's budget is used for NIH buildings
and facilities and the National Library of Medicine, among other
things.
[14] NIH began accepting applications that name multiple principal
investigators in February 2007.
[15] Typically, grantees develop proposals for multiyear projects for
which the first year of funding is provided through competitive grants,
with a recommended period of support that can be more than 1 year. For
subsequent years, grantees may obtain funding through noncompetitive
continuation grants.
[16] NIH is currently transitioning from general clinical research
center grants to a new type of similar grant called clinical and
translational science awards.
[17] NIH issues program announcements and requests for applications to
signal interest in receiving applications for grants and cooperative
agreements. NIH issues requests for proposals to solicit contract
proposals. Funding announcements are issued by one or more institute(s)
or center(s). Other institutes and centers with potential interest in
funding some of the research may be listed on the funding announcement.
[18] In some cases, research is cofunded by two or more institutes and
centers after separate review by each of the funding institute's and
center's council or board. In these cases, one institute or center--the
primary funding institute or center--assumes administrative
responsibility for the grant. Applications submitted in response to
requests for applications--for which funds have been set aside--are
reviewed as a group.
[19] NIDCR's mission is to improve oral, dental, and craniofacial
health through research, research training, and the dissemination of
information.
[20] Of the 27 institutes and centers, 24 have the authority to award
grants.
[21] In addition to members from NIH, this working group includes
representatives from other federal agencies, including the Agency for
Healthcare Research and Quality, the Food and Drug Administration, the
Centers for Disease Control and Prevention, and the Department of
Defense. Nonfederal representatives from patient advocacy groups and
academia participate as nonvoting observers.
[22] Some of these projects were scheduled to end after fiscal year
2006.
[23] Some institutes and centers reported which specific subprojects of
research program projects or centers were TMJD-related; other
institutes and centers reported which overall research program projects
or centers included TMJD-related subprojects. In this report, we use
the term "project" to refer to both overall projects and subprojects
unless otherwise specified.
[24] NIDCR officials identified career development awards as an
important means of supporting TMJD-related research.
[25] Pathophysiology refers to the functional changes that accompany a
particular syndrome or disease.
[26] Temporary use of an intraoral splint is a common, conservative
dental treatment for TMJDs. There are different types of such splints.
For example, one type is designed to help alter the jaw's posture to a
more open, relaxed, resting position. Another type of intraoral splint
attempts to decrease the compression load on the joint.
[27] SCOR here refers to Specialized Center of Research.
[28] Mechanical loading involves the exertion of force on the joint.
[29] As of February 2008, NIH officials reported that they have not
funded any TMJD-related research applications in response to these
three funding announcements. NIDCR officials reported that they had
received 9 such applications, but that none of them were considered to
be of sufficient scientific merit to warrant funding. ORWH officials
informed us that NIH had not completed its scientific review of
applications received in response to these announcements, which have
not expired.
[30] Applications submitted in response to an expired program
announcement may be delayed in the review process or returned without
review. In contrast, NIH does not accept applications submitted in
response to expired requests for applications.
[31] The following institutes issued funding announcements for these
areas of research: National Cancer Institute, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institute of
Biomedical Imaging and Bioengineering, NIDCR, National Institute of
Neurological Disorders and Stroke, National Institute of Nursing
Research, and National Institute on Deafness and Other Communication
Disorders. NIH's ORWH and Office of Behavioral and Social Sciences
Research--both within the Office of the Director--each issued one of
these funding announcements.
[32] As of February 2008, NIDCR officials reported that they funded 2
of 3 TMJD-related research applications submitted in response to the
targeted funding announcement "Neurobiology of Persistent Pain Mediated
by the Trigeminal Nerve" and 10 of 43 TMJD-related applications
submitted in response to "New Models of Pain Relevant to the Trigeminal
System." For the other targeted funding announcements, NIH officials
reported that they had either not received TMJD-related research
applications in response, or had not received TMJD-related applications
considered to be of sufficient scientific merit to warrant funding. NIH
may also fund additional applications on these areas of research that
are not submitted in response to these targeted funding announcements.
[33] As of February 2008, NIH officials reported that one application
was received and funded in response to this targeted funding
announcement that could provide specialized training in issues of
relevance to TMJDs.
[34] When we did our work, fiscal year 2006 was the most recent year
for which NIH could provide full information about the TMJD-related
projects it funded.
[35] Each year, NIH prepares an estimate of its funding for research on
TMJDs and other disorders for public distribution.
[36] For example, the National Institute of Neurological Disorders and
Stroke began reporting TMJD-related research in fiscal year 2004.
[37] CRISP is a publicly available database that includes information
about, and abstracts for, projects funded by NIH.
[38] In this report, we use the acronym TMJDs to refer to this set of
disorders. Some experts use the acronyms TMJ or TMD instead.
[39] GAO, Chronic Fatigue Syndrome: CDC and NIH Research Activities Are
Diverse, but Agency Coordination Is Limited, GAO/HEHS-00-98
(Washington, D.C.: June 2, 2000).
[40] NIH's online Guide for Grants and Contracts is available through
NIH's Office of Extramural Research Web site at [hyperlink,
http://grants.nih.gov/grants/guide/index.html] (accessed on Jan. 16,
2008).
[41] We excluded two targeted funding announcements on TMJDs. One of
these funding announcements notified applicants who have a currently
active NIH grant of an option to obtain supplemental funding to support
travel or workshop activities to support exchange, training, and
research collaborations between scientists in the United States and
Japan. The second excluded funding announcement was for institutional
training grants, which are not designed to support specific research
activities.
[42] We did not ask NIH to provide this information for two targeted
funding announcements--both requests for applications--with a peer
review date in 2008, for which funding decisions were not made prior to
the completion of our audit work. Applications submitted to NIH in
response to requests for applications are reviewed as a group in a
onetime competition. In contrast, applications submitted in response to
program announcements are not reviewed in a onetime competition.
[43] Some institutes and centers reported which specific subprojects of
research program projects or centers were TMJD-related; other
institutes and centers reported which overall research program projects
or centers included TMJD-related subprojects. In this report, we use
the term "project" to refer to both overall projects and subprojects
unless otherwise specified.
[44] We excluded two targeted funding announcements on TMJDs. One of
these funding announcements notified applicants with an active NIH
grant of an option to obtain supplemental funding to support travel or
workshop activities to support exchange, training, and research
collaborations between scientists in the United States and Japan. The
other excluded funding announcement signaled interest in funding
institutional training grants, which are not designed to support
specific research activities.
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