The Brain as a Therapeutic Target in TMD and Orofacial Pain: The Next Frontier in Personalized Pain Medicine and Health Technology

Abstract

There is growing evidence that the cause for the chronicity in many TMD and orofacial pain patients may lie in the brain, instead of the peripheral areas where the symptoms reside. Accumulating data, stemming primarily from the area of neuroimaging, show that the transition from acute to chronic pain appears to be due to an alteration of specific neural systems as a maladaptation to the prolonged suffering, a phenomenon called neuroplasticity. As described by William James, a pioneering American psychologist, in his book The Principles of Psychology (1890): “Plasticity […] means the possession of a structure weak enough to yield to an influence, but strong enough not to yield all at once.” He attributed this inherent ability of adaptive changes to any organic matter, especially the nervous system, granting it a special degree of plasticity. Based on this principle, prolonged pain may induce ingrained alterations in the brain, which could explain the resilience of TMD and orofacial pain to conventional treatments in countless patients.

This chapter will describe new technologies that represent a change of paradigm in personalized treatment of pain patients: They objectively evaluate and modulate in vivo neuromechanisms in the brain depending on the patient’s symptoms, even in the clinical environment, reaching far beyond the traditional clinical translational models.