Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190027
Brazilian Journal of Pain
Original Article

Use of non-invasive neuromodulation in the treatment of pain in temporomandibular dysfunction: preliminary study

Uso da neuromodulação não invasiva no tratamento da dor em disfunção temporomandibular: um estudo preliminar

Tatyanne dos Santos Falcão Silva; Melyssa Kellyane Cavalcanti Galdino; Suellen Mary Marinho dos Santos Andrade; Luciana Barbosa Sousa de Lucena; Renata Emanuela Lyra de Brito Aranha; Evelyn Thais de Almeida Rodrigues

Downloads: 0
Views: 201

Abstract

BACKGROUND AND OBJECTIVES: In temporomandibular disorder, the pain is a very present and striking symptom, with a tendency to chronicity, through mechanisms of maladaptive neuroplasticity. In the face of this, transcranial direct current stimulation appears as a possible strategy for the treatment of chronic pain in the temporomandibular disorder. This study aimed to evaluate the efficacy of anodal transcranial direct current stimulation in the pain symptoms and anxiety levels in individuals with chronic myofascial temporomandibular disorder.

METHODS: The participants received three different types of intervention in a randomized order: anodic in the primary motor cortex, in the dorsolateral prefrontal cortex and sham stimulation.

RESULTS: There were significant improvements in clinical pain in all stimulation protocols, with a relief of approximately 40% (p=0.001). There was no significant difference in the effect of the transcranial direct current stimulation between the different types of stimulation (p=0.14). There was a positive impact on anxiety symptoms, leading to a significant decrease in state anxiety levels (p=0.035) and trait (p=0.009).

CONCLUSION: The use of the transcranial direct current stimulation improved the health status of patients with chronic myofascial temporomandibular disorder, promoting pain relief, decreased level of anxiety, and quality of life.

Keywords

Orofacial pain, Rehabilitation, Transcranial stimulation by continuous current

Resumo

JUSTIFICATIVA E OBJETIVOS: Na disfunção temporomandibular, a dor aparece de forma frequente e marcante, com tendência à cronicidade, através de mecanismos de neuroplasticidade mal adaptativo. Diante disso, a estimulação transcraniana por corrente contínua surge como uma possível estratégia de tratamento da dor crônica em disfunção temporomandibular. O presente estudo objetivou avaliar a eficácia da estimulação transcraniana por corrente contínua anódica nos sintomas dolorosos e, por conseguinte, nos níveis de ansiedade em indivíduos com disfunção temporomandibular muscular crônica.

MÉTODOS: Os participantes receberam três tipos diferentes de intervenção cuja ordem foi randomizada: anódica no córtex motor primário, na região cortical dorsolateral pré-frontal e estimulação simulada.

RESULTADOS: Houve melhorias significativas para a dor clínica em todos os protocolos de estimulação, com um alívio de aproximadamente 40% (p=0,001). Não houve diferença significativa no efeito da estimulação transcraniana por corrente contínua entre os diferentes tipos de estimulação (p=0,14). Ocorreu impacto positivo sobre os sintomas de ansiedade, com diminuição significativa nos níveis de ansiedade estado (p=0,035) e traço (p=0,009).

CONCLUSÃO: O uso da estimulação transcraniana por corrente contínua melhorou a condição de saúde dos portadores de disfunção temporomandibular muscular crônica, promovendo um alívio do quadro álgico, diminuição do nível de ansiedade, além de gerar qualidade de vida.

Palavras-chave

Dor orofacial, Estimulação transcraniana por corrente contínua, Reabilitação

References

Okeson JP. Tratamento das desordens temporomandibulares e oclusão. 2013.

Sessle BJ. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates. Crit Rev Oral Biol Med. 2000;11(1):57-91.

Blyth FM, Van Der Windt DA, Croft PR. Chronic disabling pain: a significant public health problem. Am J Prev Med. 2015;49(1):98-101.

Shueb SS, Nixdorf DR, John MT, Alonso BF, Durham J. What is the impact of acute and chronic orofacial pain on quality of life?. J Dent. 2015;43(10):1203-10.

. 2013.

Mansour AR, Farmer MA, Baliki MN, Apkarian AV. Chronic pain: the role of learning and brain plasticity. Restor Neurol Neurosci. 2014;32(1):129-39.

Rodriguez-Raecke R, Niemeir A, Ihle K, Ruether W, May A. Brain gray matter decrease in chronic pain is the consequence and not the cause of pain. J Neurosci. 2004;29(44):13746-50.

Ji RR, Woolf CJ. Neuronal plasticity and signal transduction in nociceptive neurons: implications for the initiation and maintenance of pathological pain. Neurobiol Dis. 2001;8(1):1-10.

Piccin CF, Pozzebon D, Chiodelli L, Boufleus J, Pasinato F, Corrêa EC. Aspectos clínicos e psicossociais avaliados por critérios de diagnóstico para disfunção temporomandibular. Rev CEFAC. 2016;18(1):113-9.

Chisnoiu AM, Picos AM, Popa S, Chisnoiu PD, Lascu L, Picos A. Factors involved in the etiology of temporomandibular disorders - a literature review. Clujul Med. 2015;88(4):473-8.

Sipilä K, Mäki P, Laajala A, Taanila A, Joukamaa M, Veijola J. Association of depressiveness with chronic facial pain: a longitudinal study. Acta Odontol Scand. 2013;71(3-4):644-9.

Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. J Headache Pain. 2013;14:37.

Maeoka H, Matsuo A, Hiyamizu M, Morioka S, Ando H. Influence of transcranial direct current stimulation of the dorsolateral prefrontal cortex on pain related emotions: a study using electroencephalographic power spectrum analysis. Neurosci Lett. 2012;512(1):12-6.

Yoon HJ, Lee SH, Hur JY, Kim HS, Seok JH, Kim HG. Relationship between stress levels and treatment in patients with temporomandibular disorders. J Korean Assoc Oral Maxillofac Surg. 2012;38:326-31.

Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. Journal of Consult Clin Psychol. 2002;70(3):678-90.

Auerbach SM, Laskin DM, Frantsve LM, Orr T. Depression, pain, exposure to stressful life events, and long-term outcomes in temporomandibular disorder patients. J Oral Maxillofac Surg. 2001;59(6):628-34.

Wieckiewicz M, Boening K, Wiland P, Shiau YY, Paradowska-Stolarz A. Reported concepts for the treatment modalities and pain management of temporomandibular disorders. J Headache Pain. 2015;16:106.

List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses. J Oral Rehabil. 2010;37(6):430-51.

Gremillion HA. Multidisciplinary diagnosis and management of orofacial pain. Gen Dent. 2002;50(2):178-89.

Fregni F, Nitsche MA, Loo CK, Brunoni AR, Marangolo P, Leite J. Regulatory considerations for the clinical and research use of transcranial direct current stimulation (tDCS): review and recommendations from an expert panel. Clin Res Regul Aff. 2015;32(1):22-35.

O'Connell NE, Wand BM, Marston L, Spencer S, Desouza LH. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev. 2014;11(4).

Fregni F, Boggio PS, Brunoni AR. Neuromodulação terapêutica: Princípios e avanços da estimulação cerebral não invasiva em neurologia, reabilitação, psiquiatria e neuropsicologia. 2012.

Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527(Pt3):633-9.

Choi YH, Jung SJ, Lee CH, Lee SU. Additional effects of transcranial direct-current stimulation and trigger-point injection for treatment of myofascial pain syndrome: a pilot study with randomized, single-blinded trial. J Altern Complement Med. 2014;20(9):698-704.

Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation. Neuroscientist. 2011;17(1):37-53.

Antal A, Terney D, Kühnl S, Paulus W. Anodal transcranial direct current stimulation of the motor cortex ameliorates chronic pain and reduces short intracortical inhibition. J Pain Symptom Manage. 2010;39(5):890-903.

George MS, Aston-Jones G. Noninvasive techniques for probing neurocircuitry and treating illness: vagus nerve stimulation (VNS), transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). Neuropsychopharmacology. 2010;35(1):301-16.

Donnell A, Nascimento T, Lawrence M, Gupta V, Zieba T, Truong DQ. High-definition and non-invasive brain modulation of pain and motor dysfunction in chronic TMD. Brain Stimul. 2015;8(6):1085-92.

Jensen MP, Day MA, Miró J. Neuromodulatory treatments for chronic pain: efficacy and mechanisms. Nat Rev Neurol. 2014;10(3):167-78.

Sakrajai P, Janyacharoen T, Jensen MP, Sawanyawisuth K, Auvichayapat N, Tunkamnerdthai O. Pain reduction in myofascial pain syndrome by anodal transcranial direct current stimulation combined with standard treatment: a randomized controlled study. Clin J Pain. 2014;30(12):1076-83.

Knotkova H, Nitsche MA, Cruciani RA. Putative physiological mechanisms underlying tDCS analgesic effects. Front Hum Neurosc. 2013;7:628.

Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017;128(1):56-92.

DosSantos MF, Ferreira N, Toback RL, Carvalho AC, DaSilva AF. Potential mechanisms supporting the value of motor cortex stimulation to treat chronic pain syndromes. Front Neurosci. 2016;10:18.

Oliveira LB, Lopes TS, Soares C, Maluf R, Goes BT, Sá KN, Baptista AF. Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised-controlled trial. J Oral Rehabil. 2015;42(10):723-32.

Valle A, Roizenblatt S, Botte S, Zaghi S, Riberto M, Tufik S. Efficacy of anodal transcranial direct current stimulation (tDCS) for the treatment of fibromyalgia: results of a randomized, sham-controlled longitudinal clinical trial. J Pain Manag. 2009;2(3):353-61.

Fregni F, Freedman S, Pascual-Leone A. Recent advances in the treatment of chronic pain with non-invasive brain stimulation techniques. Lancet Neurol. 2007;6(2):188-91.

Fregni F, Gimenes R, Valle AC, Ferreira MJ, Rocha RR, Natalle L. A randomized, sham-controlled, proof of principle study of transcranial direct current stimulation for the treatment of pain in fibromyalgia. Arthritis Rheum. 2006;54(12):3988-98.

Seminowicz DA, Moayedi M. The dorsolateral prefrontal cortex in acute and chronic pain. J Pain. 2017;18(9):1027-35.

Cruccu G, Garcia-Larrea L, Hansson P, Keindl M, Lefaucheur JP, Paulus W. EAN guidelines on central neurostimulation therapy in chronic pain conditions. Eur J Neurol. 2016;23(10):1489-99.

Boggio PS, Zaghi S, Fregni F. Modulation of emotions associated with images of human pain using anodal transcranial direct current stimulation (tDCS). Neuropsychologia. 2009;47(1):212-7.

Vaseghi B, Zoghi M, Jaberzadeh S. Does anodal transcranial direct current stimulation modulate sensory perception and pain? A meta-analysis study. Clin Neurophysiol. 2014;125(9):1847-58.

O'Connell NE, Marston L, Spencer S, DeSouza LH, Wand BM. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev. 2018.

Biaggio AM, Natalício L, Spielberger CD. Desenvolvimento da forma experimental em português do Inventário de Ansiedade Traço-Estado (IDATE) de Spielberger. Arq Bras Psicol Aplicada. 1977;29(3):31-44.

Domingues L, Cruz E. Adaptação cultural e contributo para a validação da escala Patient Global Impression of Change. Ifisionline. 2011;2(1):31-7.

Bolton JE, Wilkinson RC. Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manipulative Physiol Ther. 1998;21(1):1-7.

O'Neill F, Sacco P, Nurmikko T. Evaluation of a home-based transcranial direct current stimulation (tDCS) treatment device for chronic pain: study protocol for a randomised controlled trial. Trials. 2015;16:186.

Amatachaya A, Auvichayapat N, Patjanasoontorn N, Suphakunpinyo C, Ngernyam N, Aree-Uea B. Effect of anodal transcranial direct current stimulation on autism: a randomized double-blind crossover trial. Behav Neurol. 2014;2014.

Wrigley PJ, Gustin SM, McIndoe LN, Chakiath RJ, Henderson LA, Siddall PJ. Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: a randomized controlled trial. Pain. 2013;154(10):2178-84.

Bagis B, Ayaz EA, Turgut S, Durkan R, Özcan M. Gender difference in prevalence of signs and symptoms of temporomandibular joint disorders: a retrospective study on 243 consecutive patients. Int J Med Sci. 2012;9(7):539-44.

Schmid-Schwap M, Bristela M, Kundi M, Piehslinger E. Sex-specific differences in patients with temporomandibular disorders. J Orofac Pain. 2013;27(1):42-50.

Warren MP, Fried JL. Temporomandibular disorders and hormones in women. Cells Tissues Organs. 2001;169(3):187-92.

Brunoni AR, Amadera J, Berbel B, Volz MS, Rizzerio BG, Fregni F. A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol. 2011;14(8):1133-45.

Brunoni AR, Nitsche MA, Bolognini N, Bikson M, Wagner T, Merabet L. Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions. Brain Stimul. 2012;5(3):175-95.

Legrain V, Iannetti GD, Plaghki L, Mouraux A. The pain matrix reloaded: a salience detection system for the body. Prog Neurobiol. 2011;93(1):111-24.

DosSantos MF, Love TM, Martikainen IK, Nascimento TD, Fregni F, Cummiford C. Immediate effects of tDCS on the µ-opioid system of a chronic pain patient. Front Psychiatry. 2012;3:93.

Bertoli E, de Leeuw R. Prevalence of suicidal ideation, depression, and anxiety in chronic temporomandibular disorder patients. J Oral Facial Pain Headache. 2016;30(4):296-301.

Brighina F, De Tommaso M, Giglia F, Scalia S, Cosentino G, Puma A. Modulation of pain perception by transcranial magnetic stimulation of left prefrontal cortex. J Headache Pain. 2011;12(2):185-91.

Andrade SM, de Brito Aranha REL, de Oliveira EA, de Mendonça CTPL, Martins WKN, Alves NT. Transcranial direct current stimulation over the primary motor vs prefrontal cortex in refractory chronic migraine: a pilot randomized controlled trial. J Neurol Sci. 2017;378:225-32.

Antal A, Paulus W, Rohde V. New results on brain stimulation in chronic pain. Neurol Int Open. 2017;1:E312-5.

Greene CS, Goddard G, Macaluso GM, Mauro G. Topical review: placebo responses and therapeutic responses. How are they related?. J Orofac Pain. 2009;23(2):92-107.

Holmes RD, Tiwari AK, Kennedy JL. Mechanisms of the placebo effect in pain and psychiatric disorders. Pharmacogenomics J. 2016;16(6):491-500.

DosSantos MF, Martikainen IK, Nascimento TD, Love TM, DeBoer MD, Schambra HM. Building up analgesia in humans via the endogenous µ-opioid system by combining placebo and active tDCS: a preliminary report. PLoS One. 2014;9(7).

Wager TD, Atlas LY. The neuroscience of placebo effects: connecting context, learning and health. Nat Rev Neurosci. 2015;16(7):403-18.


Submitted date:
09/30/2018

Accepted date:
03/11/2019

5f21d40c0e8825ea19e56d7d brjp Articles

BrJP

Share this page
Page Sections