Temporomandibular Dysfunction (TMD) Clinical Trial
Official title:
Effect of Noninvasive Neuromodulation on Chronic Pain and Anxiety Levels in Individuals With Temporomandibular Disorders
1. BACKGROUND: Temporomandibular Dysfunction (TMD) is a disease characterized by a set of
signs and symptoms that may include joint noise, pain in the mastication muscles,
limitation of mandibular movements, facial pain, joint pain and / or dental wear. Pain
appears as a very present and striking symptom, with a tendency to chronicity. This is a
difficult treatment condition often associated with psychological factors such as
anxiety. Chronic pain involved modifications in the neuronal excitability, therefore,
the neuromodulation withTranscranial direct current stimulation (tDCS) appears as a
possible strategy for the treatment. Some studies have shown improvement in subjects
with chronic pain using tDCS, however, it needs further investigation of its therapeutic
effect.
2. PROBLEM: Despite the wide range of strategies used to treat patients with TMD, some
patients have a temporary and / or unsatisfactory relief response, which generates
hypotheses that emotional components often underlie treatment refractoriness, and
development of a memory for pain. Thus, it is evident the need for a therapy that acts
directly on the central nervous system (CNS). This action can occur through medications,
however, many individuals are refractory or have side effects such as dependence and /
or tolerance. In this way, the importance of new treatments involving neuromodulation
and neuroplasticity mechanisms, such as tDCS, is highlighted, which may become a
complementary alternative to the different types of treatment already in use. Besides
corroborating with the need to give preference to reversible and non-invasive
procedures.
3. HYPOTHESIS: The investigators believe that the use of anodic tDCS in the treatment of
patients with TMD presenting with chronic pain will have a positive effect, promoting a
decrease in painful symptoms through a Central Nervous System (neuromodulation) action
in comparison to placebo stimulation. Because of the mutual influence between pain and
psychological factors, it is expected that the analgesic effect will have a positive
effect on anxiety levels. In addition, it is believed that a more intense analgesic
effect occurs in the DLPF stimulation group of the cortex compared to the M1 stimulation
group, since this region demonstrates to be responsible for the processing of the
emotional component of the pain, often underlying the refractoriness to treatment
4. AIM: To evaluate and compare the efficacy of anodic tDCS, applied in different cortical
regions (M1 and DLPFC), in the pain and anxiety levels in individuals with chronic pain
due muscular TMD.
| Status | Recruiting |
| Enrollment | 10 |
| Est. completion date | February 16, 2018 |
| Est. primary completion date | January 26, 2018 |
| Accepts healthy volunteers | No |
| Gender | All |
| Age group | 18 Years to 60 Years |
| Eligibility |
Inclusion Criteria: - Age between 18-60 years, both male and female - Provide informed consent to participate in the study; - Having a diagnosis of muscular pain DTM according to IA and IB, axis I RDC/TMD - Visual analogic scale (VAS) score from 4 to 10 for six months or longer - Presence of moderate depressive symptoms through SCL-90 scale evaluation of Axis II, (RDC / TMD) - Not pregnant; - Not have contraindications to tDCS, such as metal implants on the head or implanted brain devices; - Not have history of alcohol or drugs abuse within the past 6 months as self-reported - Not use of carbamazepine within the past 6 months as self reported - Not have any history of epilepsy, stroke, moderate-to-severe traumatic brain injury or severe migraines - Not have history of neurosurgery as self-reported - Not have history of major psychiatric disorders such as schizophrenia and bipolar disorder - Not have any other previously diagnosed disorder with symptoms similar to the DTM, such as fibromyalgia. Exclusion Criteria: - Two absences during treatment sessions; - During the research, go against some criteria of inclusion mentioned above, as in the case of women, getting pregnant. |
| Country | Name | City | State |
|---|---|---|---|
| Brazil | Tatyanne Falcão | João Pessoa | Paraíba |
| Lead Sponsor | Collaborator |
|---|---|
| Federal University of Paraíba |
Brazil,
| Type | Measure | Description | Time frame | Safety issue |
|---|---|---|---|---|
| Primary | Change from baseline in Visual Analogic Scale | The visual analogic scale allows us to convert subjective sensations as pain on numerical data. A 10cm scale where 0cm is no pain and 10cm the worse imaginable pain, will be used and the subjects will be asked to mark a point on the scale representing their pain. This instrument will be used to compare the VAS values before and after the intervention. | 4 months | |
| Secondary | Patient Global Impression of Change Scale (PGICS) | The Patient Global Impression of Change Scale (PGICS) is an understandable, adequate, easy-to-use instrument capable of measuring the perception of change in health status and satisfaction with the treatment of individuals with chronic musculoskeletal pain. It is a one-dimensional measurement instrument in which individuals rate their improvement associated with intervention on a 7-item scale ranging from 1 (no change) to 7 (Much better). | 4 months | |
| Secondary | State-Trait Anxiety Inventory | The STAI is used to evaluate objectively both aspects of anxiety: trait and state. Thus, the anxiety state will assess the level of anxiety at the specific time the test is performed and the anxiety trait will investigate the individual's willingness to react to stress situations. It is an instrument with 40 descriptive statements about the feelings of the person, distributed in two parts (trace and state of anxiety), in which each part is formed by 20 affirmations and the answers are given in scale of the type Likert of four points (1 - absolutely not the 4 - very much). The score in each questionnaire ranges from 20 to 80, with an anxiety level rating of: low (20 to 33), mean (33 to 49) and high (49 to 80). | 4 months |
| Status | Clinical Trial | Phase | |
|---|---|---|---|
| Completed |
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