Transcranial direct current stimulation and exercises for treatment of chronic temporomandibular disorders: a blind randomised‐controlled trial

Abstract

To evaluate the effect of adding transcranial direct current stimulation (tDCS) to exercises for chronic pain, dysfunction and quality of life in subjects with temporomandibular disorders (TMD). Participants were selected based on the RDC/TMD criteria and assessed for pain intensity, pressure pain threshold over temporomandibular joint and cervical muscles and quality of life. After initial assessment, all individuals underwent a 4-week protocol of exercises and manual therapy, together with active or sham primary motor cortex tDCS. Stimulation was delivered through sponge electrodes, with 2 mA amplitude, for 20 min daily, over the first 5 days of the trial. A total of 32 subjects (mean age 24.7 ± 6.8 years) participated in the evaluations and treatment protocol. Mean pain intensity pre-treatment was 5.5 ± 1.4 for active tDCS group, and 6.3 ± 1.2 for sham tDCS. Both groups showed a decrease in pain intensity scores during the trial period (time factor--F(4.5,137.5) = 28.7, P < 0.001; group factor--F(1.0,30.0 = 7.7), P < 0.05). However, there were no differences between the groups regarding change in pain intensity (time*group interaction--F(4.5,137.5) = 1.5, P = 0.137). This result remained the same after 5 months (t-test t = 0.29, P > 0.05). Pressure pain thresholds decrease and improvement in quality of life were also noticeable in both groups, but again without significant differences between them. Absolute benefit increase was 37.5% (CI 95%: -15.9% to 90.9%), and number needed to treat was 2.66. This study suggests that there is no additional benefit in adding tDCS to exercises for the treatment of chronic TMD in young adults.

Low intensity transcranial electric stimulation: Safety, ethical, legal regulatory and application guidelines

“…The latter event could be interpreted as a lack of tDCS efficacy in treating the pain syndrome rather than as an AE produced by the stimulation. These pain therapy studies also reported three cases of skin burn due to the electrodes, which healed within a few days, leaving a small scar in one patient (Oliveira et al, 2015). …”

Effects of exercise therapy on painful temporomandibular disorders

“…An RCT study showed the effect of transcranial direct current stimulation (tDCS) together with exercises such as manipulative stretch and self‐training of mouth opening (A‐3) that decreased pain intensity and improved jaw opening range in patients with myogenic TMD . On the other hand, therapeutic exercises including active mouth opening exercise (A‐3), muscle strengthening exercise (B) and stretch (A‐3) did not show significant differences compared to interocclusal appliance treatment, even though both treatments were significantly effective in decreasing pain intensity .…”

An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives

“…The mechanism of pain reduction is believed to be mediated by direct or indirect activation of functional connectivity between PFC and the limbic system, which is involved in pain inhibition and emotional function (mood and affect) . tDCS has recently been used to manage oro‐facial pain, but its therapeutic effectiveness for chronic temporomandibular disorders is unclear . These modalities are new, and well‐designed RCTs are needed in order to determine their effectiveness.…”