title: High-Definition and Non-invasive Brain Modulation of Pain and Motor Dysfunction in Chronic TMD.
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 < 0.01); and sectional pain area, intensity and their sum measures contralateral to putative M1 stimulation during the treatment week (P < 0.01). No changes in emotional values were shown between groups.
  
  
  CONCLUSIONS
  Putative M1 stimulation by HD-tDCS selectively improved meaningful clinical sensory-discriminative pain and motor measures during stimulation, and up to four-weeks post-treatment in chronic myofascial TMD pain patients.
authors.affiliation: Headache & Orofacial Pain Effort (H.O.P.E.), Biological & Materials Sciences Department, University of Michigan School of Dentistry, USA; Department of Orthodontics & Pediatric Dentistry, School of Dentistry, University of Michigan, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Donnell
authors.affiliation: Headache & Orofacial Pain Effort (H.O.P.E.), Biological & Materials Sciences Department, University of Michigan School of Dentistry, USA.
authors.forename: Thiago
authors.initials: T
authors.lastname: D Nascimento
authors.affiliation: Headache & Orofacial Pain Effort (H.O.P.E.), Biological & Materials Sciences Department, University of Michigan School of Dentistry, USA.
authors.forename: Mara
authors.initials: M
authors.lastname: Lawrence
authors.affiliation: Headache & Orofacial Pain Effort (H.O.P.E.), Biological & Materials Sciences Department, University of Michigan School of Dentistry, USA.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Headache & Orofacial Pain Effort (H.O.P.E.), Biological & Materials Sciences Department, University of Michigan School of Dentistry, USA.
authors.forename: Tina
authors.initials: T
authors.lastname: Zieba
authors.affiliation: Department of Biomedical Engineering, The City College of New York, City University of New York, New York, NY, USA.
authors.forename: Dennis Q
authors.initials: DQ
authors.lastname: Truong
authors.affiliation: Department of Biomedical Engineering, The City College of New York, City University of New York, New York, NY, USA.
authors.forename: Marom
authors.initials: M
authors.lastname: Bikson
authors.affiliation: Soterix Medical, New York, NY, USA.
authors.forename: Abhi
authors.initials: A
authors.lastname: Datta
authors.affiliation: Department of Biostatistics, School of Public Health, University of Michigan, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Bellile
authors.affiliation: Headache & Orofacial Pain Effort (H.O.P.E.), Biological & Materials Sciences Department, University of Michigan School of Dentistry, USA; Molecular & Behavioral Neuroscience Institute (MBNI), University of Michigan, USA. Electronic address: adasilva@umich.edu.
authors.forename: Alexandre F
authors.initials: AF
authors.lastname: DaSilva
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000503:physiopathology; D059350:Chronic Pain / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology; D019957:Motor Skills Disorders / Q000503:physiopathology / Q000628:therapy*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D016037:Single-Blind Method; D013705:Temporomandibular Joint Disorders / Q000503:physiopathology / Q000628:therapy*; D065908:Transcranial Direct Current Stimulation / Q000379:methods*
keywords: Clinical trial; Pain; PainTrek; Temporomandibular disorder; Transcranial direct current stimulation