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Temporomandibular DisorderNCT04086732

Assessment of Nociceptive Processing Among Patients With Temporo-mandibular Disorders

A study testing High-frequency electrical stimulation in people with Temporomandibular Disorder, run by Université Catholique de Louvain at 1 site in Belgium.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This case control study will investigate the physiological effect of nociceptive input in individuals with temporomandibular disorders. To do so, the investigators will compare the development of secondary hyperalgesia following high frequency electrical stimulation (HFS) of skin nociceptors in the forearms for up to… Read more about this study

Who is it for?
Ages 18 to 50 years, women onlyHealthy volunteers can take part
Conditions the study is for
Temporomandibular Disorder
What is being tested?
High-frequency electrical stimulation
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteBelgium
Study dates
11 Jan 2021to 29 Mar 2022
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 50 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Females aged between 18 and 50 years.
  • BMI between 17 and 30.
  • Ability to provide written informed consent.
  • Females aged between 18 and 50 years.
  • BMI between 17 and 30.
  • Ability to provide written informed consent.
  • Chronic TMD (for at least 3 months) as a main complain (according to the DC/TMD), with an average of at least 3/10 on a pain numerical rating scale during the past month in the orofacial region.

Who cannot join

  • Evidence of psychiatric/inflammatory/neurological or metabolic comorbidities on direct questioning as this study is meant to focus on musculoskeletal disorders.
  • Evidence of skin alteration on the volar forearms that may interfere with HFS.
  • Any substance abuse, or the use of antidepressant or neuroleptic medication as these may interfere with the psychophysical examination.
  • Any painful musculoskeletal disorder.
  • Lack of dental check-ups during the last 12 months.
  • Evidence of psychiatric/inflammatory/neurological or metabolic comorbidities on direct questioning as this study is meant to focus on musculoskeletal disorders.
Show all 9Show fewer
  • Evidence of skin alteration on the volar forearms that may interfere with HFS.
  • Any substance abuse, or the use of antidepressant or neuroleptic medication as these may interfere with the psychophysical examination.
  • Lack of dental check-ups during the last 12 months

Trial locations and contacts

1 site in 1 country.

Belgium1 site
  • Cliniques universitaires St-Luc

    Brussels, 1200

Other trials in Belgium

About this study

Official title: Assessment of Generalized Alterations in Nociceptive Processing Among Patients Presenting With Temporo-mandibular Disorders

This case control study will investigate the physiological effect of nociceptive input in individuals with temporomandibular disorders. To do so, the investigators will compare the development of secondary hyperalgesia following high frequency electrical stimulation (HFS) of skin nociceptors in the forearms for up to 48 hours in individuals with chronic TMD (as a main complain) and in healthy controls. Furthermore, the investigators will evaluate the association between the response to HFS and various factors, such as demographic, psychosocial and pain-related clinical factors.

Read the detailed description

This control study is designed to compare the development of secondary hyperalgesia following high frequency electrical stimulation (HFS) of skin nociceptors in the forearms in individuals with chronic TMD (as a main complain) and in healthy controls.

During the first part of the experiment (time1, day 1), all potential participants will fill a basic demographic questionnaire concerning their age, weight, height, and current medications (appendix 2). Participants with TMD will be diagnosed according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). The DC/TMD includes the following questionnaires: the Graded Chronic Pain Scale, the Jaw Functional Limitation scale, the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9 and -15 and the Oral Behaviors Checklist. In addition, participants will be asked to fill the Central sensitization inventory questionnaire, as well as the symptom Severity Scale. Lastly, the investigators will evaluate the distribution of pain by asking participants to draw the pain that they felt during the past 7 days on a digital tablet. This will allow us to determine the total area of pain of each participant, as well as the Widespread Pain Index. Subjects will also be asked to provide a rating of their average pain for the last 24h

The psychophysical evaluation will be conducted later on the same day (day1). Subjects will be asked to provide a rating of their average pain at present time (time 2). Then, participants will be familiarized with the different procedures involved in the experiment.

Pressure pain thresholds will be assessed on the temporalis muscle, the trapezius muscle, and tibialis anterior (time 3).

The intensity of pain resulting from pinprick stimulation and allodynia in the area surrounding the electrode ("test area") will be assessed, as well as on the homologous site of the contralateral control arm before HFS (time 4).

Then HFS will be applied (time 5) on the left or right volar forearm (10 cm distal to the cubital fossa). HFS will consist in trains of transcutaneous electrical stimuli consisting of 42 Hz trains (pulse width: 2 ms) lasting 1 s each. The trains will be repeated 12 times. Each train will be separated by several 10 seconds of rest. The intensity of each stimulus will be set to 5 milliampere.

The of pain resulting from pinprick stimulation and allodynia in the area surrounding the electrode ("test area") will be assessed 30 min after HFS (in a counterbalanced order) on the homologous site of the contralateral control arm (time 6).

The extent of secondary hyperalgesia will be assessed approximately 45 min following HFS (time 7).

Then, they will be asked assess the presence of secondary hyperalgesia in the test-site 24 (time 8, day 2) and 48 hours (time 9, day 3) following HFS with with calibrated neurological examination pins (Neuropen, Owen-Mumford Ltd, Oxford, UK).

6 months after their initial assessment (time 10, day 180), if they gave their consent for long-term follow-up, patients will be asked to fill the following questionnaires again

Being tested
High-frequency electrical stimulation
Keywords
central sensitization, high-frequency stimulation
Medical subject headings
Temporomandibular Joint Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • High-frequency electrical stimulationProcedure or surgery

    High-frequency stimulation will be applied on the volar forearm (6-10 cm distal to the cubital fossa). To avoid any confounding effect of handedness, the arm onto which HFS will be applied twice (dominant vs nondominant) will be counterbalanced across participants. HFS will consist of 12 trains of 42 Hz electrical pulses lasting 1 s each. The time interval between each train will be 10 s. The intensity of stimulation will be milliampere. Electrical pulses will be delivered to the skin using a specifically-designed electrode designed: the cathode consists of 16 blunt stainless-steel pins with a diameter of 0.2 mm protruding 1 mm from the base. The 16 pins are placed in a circle with a diameter of 10 mm. The anode consists of a surrounding stainless-steel ring having an inner diameter of 22 mm and an outer diameter of 40 mm. This procedure induces secondary pinprick hyperalgesia (an increase in pinprick sensitivity in a large area of the skin).

Study groups in NCT04086732
Study groupRoleWhat they receive
Temporomandibular disorderExperimentalNot described
Receives: Procedure: High-frequency electrical stimulation
Healthy controlExperimentalNot described
Receives: Procedure: High-frequency electrical stimulation

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. The extent of secondary hyperalgesia on the forearm in the proximo-distal direction 45 minutes after HFS

    The area of secondary hyperalgesia (cm square) will be assessed with a calibrated 128 millinewton pinprick probe. Pokes of 1-second duration will be provided at a frequency of 0.5 Hz, starting well outside and approaching the stimulation site with steps of 0,5 cm from 4 different directions towards the application site. Participants will be asked to keep their eyes closed during the entire mapping procedure

    Measured: After HFS and the assessment of pain resulting from pinprick stimulation and allodynia (time 7). This outcome is taken at day 1 at time 7.

Secondary outcomes (21)
  1. Age

    Self-declared age of the subject

    Measured: During the initial evaluation (time 1). This outcome is taken at day 1 at time 1.

  2. Weight

    Self-declared weight of the subject

    Measured: At baseline (time 1). This outcome is taken at day 1 at time 1.

  3. Height

    Self-declared height of the subject

    Measured: At baseline (time 1). This outcome is taken at day 1 at time 1.

  4. The TMD diagnosis according to the diagnostic criteria for temporomandibular disorders (DC/TMD)

    TMD subgroup based on the DC/TMD: Myalgia, Arthralgia, Headache attributed to TMD, degenerative joint disease, disc displacement with reduction, disc displacement with reduction with intermittent locking, disc displacement with reduction with limited opening, disc displacement with reduction without limited opening, or subluxation.

    Measured: At baseline (time 1). This outcome is taken at day 1 at time 1.

  5. Graded chronic pain scale

    questionnaire assessing TMD-related pain intensity and disability: The score will range from grade 0 (no TMD pain in prior 6 months) to grade IV (High disability, severly limiting)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  6. Jaw functional limitation scale

    Questionnaire assessing limitations across mastication, jaw mobility, and verbal and emotional expression often accompanying TMD. The score will range from 0 (law functional limitation) to 10 (high functional limitation)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  7. Generalized anxiety disorder-7

    Questionnaire assessing anxiety. The score will range from 0 (no anxiety) to 27 (severe anxiety)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  8. Patient health questionnaire-9

    Questionnaire assessing depression symptoms. The score will range from 1 (minimal depression) to 27 (severe depression)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  9. Patient health questionnaire-15

    Questionnaire assessing overall physical symptoms commonly associated with TMD. The score will range from 0 (minimal physical symptoms) to 30 (high physical symptoms)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  10. Oral Behaviors Checklist

    Questionnaire assesses the frequency of oral parafunctional behaviors. The score will range from 0 (no oral parafunctional behaviors) to 84 (high oral parafunctional behavior frequency)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  11. Central sensitization inventory

    Questionnaire assessing symptoms and comorbidities that are presumed to be associated with central sensitization. The score will range from 0 (no symptoms and comorbidities presumed to be associated with central sensitization) to 100 (extreme symptoms and comorbidities presumed to be associated with central sensitization).

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  12. Symptom severity scale

    Questionnaire assessing the severity of symptoms associated with fibromyalgia, a condition frequently associated with TMD. The score will range from 0 (low severity) to 12 (high severity).

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  13. The distribution of pain

    Pain felt during the past 7 days drawn on a digital table

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  14. The Widespread pain index

    Questionnaire assessing the extent of bodily pain. The score will range from 1 (no painful body region) to 19 (19 painful body regions)

    Measured: At baseline (time 1) and 6 months after the initial assessment (time 10). This outcome is taken at day 1 at time 1 and day 180 at time 10.

  15. Average pain during the last 24h before HFS

    Pain during the last 24h on a numerical rating scale. The score will range from 0 (no pain) to 100 (worst imaginable pain)

    Measured: During the initial evaluation (time 1). This outcome is taken at day 1 at time 1.

  16. Average pain at present time before HFS: score

    Current pain on a numerical rating. The score will range from 0 (no pain) to 100 (worst imaginable pain)

    Measured: During the initial evaluation (time 2). This outcome is taken at day 1 at time 2.

  17. Pressure pain thresholds on the temporalis muscle, trapezius muscle and tibialis anterior

    Pressure pain will be assessed 3 times on each muscle, with a 30-second interstimulus interval, and the arithmetic mean of the 3 repeated measures will be used for analysis

    Measured: During the initial evaluation (time 3)]. This outcome is taken at day 1 at time 3.

  18. Baseline pain resulting from pinprick stimulation in the area surrounding the electrode ("test area") and on the homologous site of the contralateral control arm

    Participants will rate the pain induced by pin-prick stimulation in the area surrounding the electrode on a numerical rating scale ranging from 0 (no perception) to 100 (maximal pain), with 50 representing the transition from nonpainful to painful domains of sensation

    Measured: Just before HFS (time 4)]. This outcome is taken at day 1 at time 4.

  19. Allodynia in the area surrounding the electrode ("test area") and on the homologous site of the contralateral control arm

    The investigators will assess allodynia with a Cotton wisp exerting a force of 3 millinewton, a cotton wool tip fixed to an elastic strip exerting a force of 100 millinewton when slightly bent, and a standardized brush exerting a force of 200-400 millinewton

    Measured: Just before HFS (time 4) and after HFS (time 6). This outcome is taken at day 1 at time 4 and time 6.

  20. The long term persistence of secondary hyperalgesia after HFS

    Participants will assess the persistence of secondary hyperalgesia with calibrated neurological examination pins (Neuropen, Owen-Mumford Ltd, Oxford, UK). The score will range from 0 (no hyperalgesia) to 1 (hyperalgesia is present)

    Measured: 24 hours (time 8) and 48 hours after HFS (time 9). This outcome is taken at day 2 at time 8, and at day 3 at time 9.

  21. The intensity of pain resulting from pinprick stimulation 30 min after HFS

    Participants will rate the pain induced by pin-prick stimulation in the area surrounding the electrode on a numerical rating scale ranging from 0 (no perception) to 100 (maximal pain), with 50 representing the transition from nonpainful to painful domains of sensation

    Measured: Time Frame: At baseline (time 6). This outcome is taken at day 1 at time 6.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Sep 2019
  2. Study start11 Jan 2021
  3. Primary completion29 Mar 2022
  4. Study completion29 Mar 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04086732
Sponsor's protocol ID
HFS Mandibular
Status last verified
Mar 2022
First submitted
22 Aug 2019
Last updated
7 Apr 2022
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing High-frequency electrical stimulation in people with Temporomandibular Disorder, run by Université Catholique de Louvain at 1 site in Belgium.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 9 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 7 Apr 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Belgium. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

The extent of secondary hyperalgesia on the forearm in the proximo-distal direction 45 minutes after HFS (time frame: After HFS and the assessment of pain resulting from pinprick stimulation and allodynia (time 7). This outcome is taken at day 1 at time 7.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Apr 2022.

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