Transcranial Direct Current Stimulation (tDCS) Combined with Therapeutic Exercise and Cognitive Rehabilitation to Treat a Case of Burning Mouth Syndrome (BMS) Related Pain

Martín Avellanal,Juan Pablo Romero,Francisco José Sánchez-Cuesta,Aida Arroyo-Ferrer,Josué Fernández-Carnero,Yeray González-Zamorano

doi:10.3390/app112311538

Martín Avellanal, Juan Pablo Romero + Show 4 more

Open Access

https://doi.org/10.3390/app112311538

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Abstract

Burning Mouth Syndrome (BMS) is a multifactorial, chronic pain condition with neuropathic and psychogenic mechanisms. Cortical activation as well as sustained attention and executive functions have proven to be affected by chronic pain. The main objectives of this work were to test the efficacy of a multidimensional personalized pain treatment protocol and to investigate if the effects are based on psychophysical pain processing changes or cognitive effects. A 74-year-old female with 2 years of BMS received 10 sessions of a combined protocol of anodal left dorsolateral prefrontal cortex tDCS, cognitive therapy, and therapeutic exercise. The subjective perception of pain decreased by 47% after treatment but returned to the baseline at 45 days. No changes were found in objective pain measurements apart from a transient worsening of conditioned pain modulation. A large effect size was found in all functional scales, processing speed and executive control as well as sustained attention that persisted during follow-up. No changes in anxiety and depression were found. A multimodal therapeutic approach combining TDCS, cognitive rehabilitation and therapeutic exercise produces improved quality of life, disability and pain perception correlated with improvements in processing speed, executive control and sustained attention but independent of changes in psychophysical pain processing.

Highlights

Burning Mouth Syndrome (BMS) is an idiopathic and multifactorial condition characterized by a severely painful burning sensation of the tongue and mucosal tissue that can last from days to months
DiAscmususlitoidnimensional protocol based on transcranial Direct Current Stimulation, cogniAtivme–ualtttiednimtioennasliotnhaelrappryotaoncdolthbearsaepdeuotnic terxaenrsccirsaenwiaal sDaiprepcltiedCutorreanBt MStSi-mafufelactieodn w(tDomCaSn), wcoitghniati4v5e-–daatytefnotliloonwa-lutph.erapy and therapeutic exercise was applied to a BMS-affecteTdDwCoSmwanaswuitsheda p45re-dvaioyufsollyloiwn -outph.er cranial pain conditions with good results [32]
Large effect sizes were found in pain questionnaires (BPI, Pain Catastrophizing Scale (PCS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)) and disability (IDDC, OHIP), and all except LANSS continued to improve after the end of the intervention

Summary

Introduction

Burning Mouth Syndrome (BMS) is an idiopathic and multifactorial condition characterized by a severely painful burning sensation of the tongue and mucosal tissue that can last from days to months. Its underlying etiology is not well understood, and it can arise as a primary syndrome after previous oral pathologies or following an infection. Neuropsychiatric conditions such as major depression, chronic anxiety and mood disorders have been associated with BMS [1]. Cortex stimulation has been increasingly investigated as a therapeutic tool to treat chronic pain [4]. This principle has been previously used to treat orofacial pain, stimulating the motor cortex, with good results [5]

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