Management of Pain Secondary to Temporomandibular Joint Syndrome with Peripheral Nerve Stimulation

Background: Temporomandibular joint syndrome, or Costen syndrome, is a clinicallydiagnosed disorder whose most common symptoms include joint pain and clicking, difficultyopening the mouth, and temporomandibular joint discomfort. The temporomandibular joint(TMJ) is supplied by the auriculotemporal nerve, a collateral branch of the mandibular nerve(the V3 branch of the trigeminal nerve).Objectives: The aim of this study is to assess the effectiveness and safety of permanentperipheral nerve stimulation to relieve TMJ pain.Study Design: This case series is a prospective study.Setting: Pain Unit of a regional universitary hospital.Methods: The study included 6 female patients with temporomandibular pain lasting from 2to 8 years that did not respond to intraarticular local anesthetic and corticoid injections. After apositive diagnostic block test, the patients were implanted with quadripolar or octapolar leadsin the affected preauricular region for a 2-week stimulation test phase, after which the leadswere connected to a permanent implanted pulse generator. Results of the visual analog scale,SF-12 Health Survey, Brief Pain Inventory, and drug intake were recorded at baseline and at 4,12, and 24 weeks after the permanent implant.Results: Five out of 6 patients experienced pain relief exceeding 80% (average 72%) andreceived a permanent implant. The SF-12 Health Survey results were very positive for all specificquestions, especially items concerning the physical component. Patients reported returning tonormal physical activity and rest at night. Four patients discontinued their analgesic medicationand 1 patient reduced their gabapentin dose by 50%.Limitations: Sample size; impossibility of placebo control.Conclusion: Patients affected with TMJ syndrome who do not respond to conservativetreatments may find a solution in peripheral nerve stimulation, a simple technique with arelatively low level of complications.Key words: Temporomandibular joint disorder, temporomandibular joint syndrome, Costensyndrome, peripheral nerve stimulation, auriculotemporal nerve stimulation, preauricular block,clinical safety and effectiveness, trigeminal neuralgia