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Predictive role of gnathological techniques for the treatment of persistent idiopathic facial pain (PIFP)

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Abstract

Introduction/background

Persistent idiopathic craniofacial pain (PIFP) is a heterogeneous group of pain syndromes whose main characteristic is the daily presence of persistent pain for at least 3 months. The pathophysiology of PIFP is still not entirely known and probably related to biological and psychological factors. Although PIFP has been attributed to the central neuron activity, the importance of masticatory muscles as a possible pathogenic mechanism was recently demonstrated. The main purpose of our paper was to identify the physiological rest position of the mandible with minimal tonus of both the elevator and depressor muscles and the neuromuscular trajectory of mouth closing obtained by transcutaneous electrical stimulation (TENS) and maintained with the use of an occlusal device, known as orthotic.

Materials and methods

The VAS scale for facial pain and the migraine disability assessment score (MIDAS) index for patient quality of life were evaluated at the beginning of the study for the 38 subjects that came to our attention. Our research included two phases. The first phase consisted of kinesiographic and electromyographic (EMG) examinations of the masticatory muscles and a 45-min application of TENS in order to deprogram the muscular activity. Kinesio-electromyographic examinations were repeated in the second phase. The main evaluated parameter was jaw deflection or deviation on the sagittal and frontal planes before and after TENS during patient tooth occlusion. Patients that showed a significant modification of this parameter were treated with orthotics for 12 months.

Results

The results of a 12-month follow-up show a sharp reduction of the VAS (pre-orthotic 9.05, range 8–10, SD 0.8; post-orthotic 5.87, range 1–5, SD 0.7) and an improvement in the quality of life (MIDAS).

Conclusions

Our study demonstrated the usefulness of TENS as a screening method for the application of orthotics. This non-invasive and/or non-painful procedure could be a useful complementary treatment in this patient population. The results of the study also confirm the role of masticatory muscle dynamics as a possible pathogenic mechanism in patients with PIFP.

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Authors and Affiliations

  1. Dental and Oral Surgery, Headache and Facial Pain Center, Maxillo-facial and Dental Unit, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Via Francesco Sforza 35, 20122, Milan, Italy

    H. A. Didier, F. Gaffuri & A. B. Giannì

  2. Department of Neuroscience, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    A. M. Cappellari

  3. Igea Healthcare Institute, Milan, Italy

    M. Curone, V. Tullo & G. Bussone

  4. Servizio Farmaceutico, IRCCS Istituto Auxologico Italiano, Milan, Italy

    A. H. Didier

  5. C. Besta Neurological Institute Foundation and Igea Healthcare Institute, Milan, Italy

    G. Bussone

Authors
  1. H. A. Didier
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  2. A. M. Cappellari
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  3. F. Gaffuri
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  4. M. Curone
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  5. V. Tullo
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  6. A. H. Didier
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  7. A. B. Giannì
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  8. G. Bussone
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Corresponding author

Correspondence to H. A. Didier.

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The data relating to the study was collected anonymously, and the medical information contained in the medical record was only reviewed by authorized personnel.

All the procedures provided for by studies involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the World Medical Association Declaration of Helsinki of 1975, revised in Tokyo in 2004. Informed consent was obtained from all the participants in the study. The study protocol was approved by the Ethical Committee of the IRCCS Fondazione Ca’ Granda, Ospedale Maggiore, Milan (Protocol No.: 653).

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The authors declare that they have no conflict of interest.

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Didier, H.A., Cappellari, A.M., Gaffuri, F. et al. Predictive role of gnathological techniques for the treatment of persistent idiopathic facial pain (PIFP). Neurol Sci 41, 3315–3319 (2020). https://doi.org/10.1007/s10072-020-04456-9

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  • DOI: https://doi.org/10.1007/s10072-020-04456-9

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