A carregar...
Publicação
Mecanismos neurofisiológicos e abordagens terapêuticas na neurofisiologia da dor orofacial: revisão narrativa
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| Projeto de pós-graduação_38598 | 570.93 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A dor orofacial representa uma condição complexa e multifatorial, frequentemente associada à disfunção temporomandibular (DTM), cuja compreensão exige uma análise aprofundada dos mecanismos neurofisiológicos subjacentes e das abordagens terapêuticas disponíveis. Esta revisão narrativa tem como objetivo discutir, de forma crítica, e integrar os principais avanços na compreensão da fisiopatologia da dor orofacial, destacando o papel da sensibilização central, da plasticidade neural e das neurotrofinas na cronificação da dor. Além disso, são exploradas abordagens terapêuticas, farmacológicas e não farmacológicas, com ênfase em intervenções inovadoras e personalizadas que buscam otimizar os resultados clínicos e melhorar a qualidade de vida dos doentes. As evidências recentes apontam para o papel crucial do sistema trigeminal e de alterações estruturais e funcionais em áreas corticais e subcorticais na modulação da experiência dolorosa. No âmbito terapêutico, os fármacos convencionais – antiinflamatórios, analgésicos, relaxantes musculares e neuromoduladores – apresentam eficácia limitada em casos de dor persistente. Em contraste, estratégias não farmacológicas, como acupuntura, neuromodulação não invasiva (Estimulação Magnética Transcraniana (TMS) e Estimulação Transcraniana por Corrente Contínua (tDCS)) e a toxina botulínica, emergem como alternativas seguras e promissoras, sobretudo em abordagens multidisciplinares. Entre as terapias inovadoras, os canabinoides têm demonstrado potencial analgésico e neuromodulador relevante, atuando sobre os recetores do sistema endocanabinoide e contribuindo para a redução da hiperexcitabilidade neuronal associada à dor crónica. A literatura atual reforça a necessidade de uma abordagem terapêutica personalizada, que integre fatores clínicos, psicossociais e genéticos, garantindo um acompanhamento contínuo para prevenir recaídas e efeitos adversos. Conclui-se que o tratamento eficaz da dor orofacial associada à DTM exige uma perspetiva terapêutica integrada e centrada no doente, apoiada na articulação entre o conhecimento neurofisiológico e as práticas terapêuticas contemporâneas.
Orofacial pain represents a complex and multifactorial condition, frequently associated with temporomandibular dysfunction (TMD), whose understanding requires an in-depth analysis of underlying neurophysiological mechanisms and available therapeutic approaches. This narrative review aims to critically discuss and integrate the main advances in the understanding of orofacial pain pathophysiology, highlighting the role of central sensitization, neural plasticity, and neurotrophins in pain chronification. In addition, pharmacological and non-pharmacological therapeutic approaches, are explored, with emphasis on innovative and personalized interventions to optimize clinical outcomes and improve patient´s quality of life. Recent evidence points to the crucial role of the trigeminal system and to structural and functional changes in cortical and subcortical areas in modulating the pain experience. In the therapeutic context, conventional drugs – anti-inflammatories, analgesics, muscle relaxants, and neuromodulators – show limited efficacy in cases of persistent pain. In contrast, nonpharmacological strategies, such as acupuncture, non-invasive neuromodulation (Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS)), and botulinum toxin, have emerged as safe and promising alternatives, especially in multidisciplinary approaches. Among innovative therapies, cannabinoids have demonstrated relevant analgesic and neuromodulatory potential, acting on endocannabinoid system receptors and contributing to the reduction of neuronal hyperexcitability associated with chronic pain. Current literature reinforces the need for a personalized therapeutic approach that integrates clinical, psychosocial, and genetic factors, ensuring continuous monitoring to prevent relapses and adverse effects. It is concluded that the effective treatment of orofacial pain associated with TMD requires an integrated and patient-centered therapeutic perspective, supported by the articulation between neurophysiological knowledge and contemporary therapeutic practices.
Orofacial pain represents a complex and multifactorial condition, frequently associated with temporomandibular dysfunction (TMD), whose understanding requires an in-depth analysis of underlying neurophysiological mechanisms and available therapeutic approaches. This narrative review aims to critically discuss and integrate the main advances in the understanding of orofacial pain pathophysiology, highlighting the role of central sensitization, neural plasticity, and neurotrophins in pain chronification. In addition, pharmacological and non-pharmacological therapeutic approaches, are explored, with emphasis on innovative and personalized interventions to optimize clinical outcomes and improve patient´s quality of life. Recent evidence points to the crucial role of the trigeminal system and to structural and functional changes in cortical and subcortical areas in modulating the pain experience. In the therapeutic context, conventional drugs – anti-inflammatories, analgesics, muscle relaxants, and neuromodulators – show limited efficacy in cases of persistent pain. In contrast, nonpharmacological strategies, such as acupuncture, non-invasive neuromodulation (Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS)), and botulinum toxin, have emerged as safe and promising alternatives, especially in multidisciplinary approaches. Among innovative therapies, cannabinoids have demonstrated relevant analgesic and neuromodulatory potential, acting on endocannabinoid system receptors and contributing to the reduction of neuronal hyperexcitability associated with chronic pain. Current literature reinforces the need for a personalized therapeutic approach that integrates clinical, psychosocial, and genetic factors, ensuring continuous monitoring to prevent relapses and adverse effects. It is concluded that the effective treatment of orofacial pain associated with TMD requires an integrated and patient-centered therapeutic perspective, supported by the articulation between neurophysiological knowledge and contemporary therapeutic practices.
Descrição
Palavras-chave
Abordagens terapêuticas Dor orofacial Disfunção temporomandibular Mecanismos neurofisiológicos Tratamento multimodal Therapeutic approaches Orofacial pain Temporomandibular disorder Neurophysiological mechanisms Multimodal treatment