High-Definition and Non-invasive Brain Modulation of Pain and Motor Dysfunction in Chronic TMD

• Published in: Brain stimulation 2015-11, Vol.8 (6), p.1085-1092
• Main Authors: Donnell, Adam, D. Nascimento, Thiago, Lawrence, Mara, Gupta, Vikas, Zieba, Tina, Truong, Dennis Q, Bikson, Marom, Datta, Abhi, Bellile, Emily, DaSilva, Alexandre F
• Format: Article
• Language: English
• Subjects: Adult; Aged; Brain - physiopathology; Chronic Pain - physiopathology; Chronic Pain - therapy; Clinical trial; Female; Follow-Up Studies; Humans; Middle Aged; Motor Cortex - physiopathology; Motor Skills Disorders - physiopathology; Motor Skills Disorders - therapy; Neurology; Pain; Pain Management - methods; Pain Measurement; PainTrek; Single-Blind Method; Temporomandibular disorder; Temporomandibular Joint Disorders - physiopathology; Temporomandibular Joint Disorders - therapy; Transcranial direct current stimulation; Transcranial Direct Current Stimulation - methods
• ISSN: 1935-861X; 1876-4754
• DOI: 10.1016/j.brs.2015.06.008

Abstract Background Temporomandibular disorders (TMD) have a high prevalence and in many patients pain and masticatory dysfunction persist despite a range of treatments. Non-invasive brain neuromodulatory methods, namely transcranial direct current stimulation (tDCS), can provide relatively long-lasting pain relief in chronic pain patients. Objective To define the neuromodulatory effect of five daily 2x2 motor cortex high-definition tDCS (HD-tDCS) sessions on clinical pain and motor measures in chronic TMD patients. It is predicted that M1 HD-tDCS will selectively modulate clinical measures, by showing greater analgesic after-effects compared to placebo, and active treatment will increase pain free jaw movement more than placebo. Methods Twenty-four females with chronic myofascial TMD pain underwent five daily, 20-min sessions of active or sham 2 milliamps (mA) HD-tDCS. Measurable outcomes included pain-free mouth opening, visual analog scale (VAS), sectional sensory-discriminative pain measures tracked by a mobile application, short form of the McGill Pain Questionnaire, and the Positive and Negative Affect Schedule. Follow-up occurred at one-week and four-weeks post-treatment. Results There were significant improvements for clinical pain and motor measurements in the active HD-tDCS group compared to the placebo group for: responders with pain relief above 50% in the VAS at four-week follow-up ( P  = 0.04); pain-free mouth opening at one-week follow-up ( P