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Year : 2018  |  Volume : 16  |  Issue : 4  |  Page : 350-351

Time to lend an inner ear: Vestibular stimulation methods in the management of chronic orofacial pain

1 Department of Physiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Oral Pathology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Date of Submission06-Aug-2018
Date of Acceptance11-Oct-2018
Date of Web Publication29-Nov-2018

Correspondence Address:
Dr. Sai Sailesh Kumar Goothy
Department of Physiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_163_18

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How to cite this article:
Goothy SS, Manyam R. Time to lend an inner ear: Vestibular stimulation methods in the management of chronic orofacial pain. J Indian Assoc Public Health Dent 2018;16:350-1

How to cite this URL:
Goothy SS, Manyam R. Time to lend an inner ear: Vestibular stimulation methods in the management of chronic orofacial pain. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2021 May 7];16:350-1. Available from: https://www.jiaphd.org/text.asp?2018/16/4/350/246353

Dear Editor,

Pain management has been an invincible challenge in dental practice. Dental conditions and treatments are dreaded by people and affected to a large extent the utilization of oral health-care services. Further, the emotional components such as fear, anxiety, and emotions contribute to increase in the sensation of pain.[1] Hence, the management of pain is an arduous task for dentists. Vestibular apparatus comprises of receptors which are located in the inner ear and contributes to the maintenance of posture and equilibrium. Vestibular system has enormous to and fro connections with cortical and subcortical structures.[2] Stimulating the vestibular system relieves pain by modulating the somatosensory perception, that is it increases the sensitivity of touch and decreases the sensitivity of pain. Vestibular stimulation produces analgesia effect by decreasing the attention by inhibiting the visual areas. Further, vestibular system is well connected with thalamic nucleus and it is known that thalamic stimulation relieves pain. Stimulation of vestibular system excited the activity of neurons in the midbrain, and stimulation of this area was being used to alleviate pain for decades.[3] Vestibular stimulation was reported to activate the neurons of dorsal raphe nucleus which inhibits the spinal neurons located in lamina I, V, and VI. This inhibition was mediated by serotonin and norepinephrine. Vestibular system has extensive connections with the periventricular nucleus of hypothalamus. Periventricular nucleus is a part of pain inhibitory system of the central nervous system. This analgesia effect is mediated either by opioids or by neuropeptides. Vestibular projections are identified throughout the cerebellum including the vermis, flocculus, fastigial nucleus, and anterior-posterior interpositus. Spike potentials are nucleus and anterior–posterior interpositus. Spike potentials are recorded in the cerebellum followed by the vestibular stimulation. Cerebellar stimulation was reported to modulate the nociceptive responses by influencing the descending pathways to the spinal cord especially the reticular pathways. Direct projections from vestibular nucleus to nucleus of tractus solitaries and dorsal motor nucleus of vagus are reported. Stimulation of nucleus of tractus solitarius and dorsal motor nucleus of vagus produces antinociceptive responses. Vestibular stimulation may be useful as an adjunctive therapy in the management of dental pain. However, the mode of stimulation should be considered as an important factor that influences the outcome. Noninvasive stimulation like galvanic stimulation may be preferred for long-term use. Vestibular stimulation is expected to produce better results because it not only relieves pain but also relieves the negative emotions such as anxiety and promotes sleep. All these effects may reduce the quantity of analgesics used for the treatment. Recent researchers developed simple, noninvasive, and handy instruments for vestibular stimulation that has been proved for its beneficial effects in modulating the body mass composition.[4] Vestibular stimulation methods have shown success in the management of migraine and chronic poststroke pain and premenstrual syndrome.[5] Stimulation of vestibular system has been proved to be effective neuromodulating procedures for pain control in chronic pain. Hence, it was hypothesized that vestibular stimulation may be applied as an adjunctive therapy in the management of chronic orofacial pain. It is the need of time to identify the importance of vestibular stimulation and to start translational research to provide scientific evidence for the management of chronic orofacial pain through vestibular stimulation to promote oral health and quality of life.

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There are no conflicts of interest.

  References Top

Pohjola V, Lahti S, Vehkalahti MM, Tolvanen M, Hausen H. Association between dental fear and dental attendance among adults in Finland. Acta Odontol Scand 2007;65:224-30.  Back to cited text no. 1
Ventre-Dominey J. Vestibular function in the temporal and parietal cortex: Distinct velocity and inertial processing pathways. Front Integr Neurosci 2014;8:53.  Back to cited text no. 2
Young RF, Chambi VI. Pain relief by electrical stimulation of the periaqueductal and periventricular gray matter. Evidence for a non-opioid mechanism. J Neurosurg 1987;66:364-71.  Back to cited text no. 3
McGeoch PD, McKeown J, Ramachandran VS. Modulation of Body Mass Composition using Vestibular Nerve Stimulation. BioRxiv 2016. In press. doi:https://doi.org/10.1101/087692.  Back to cited text no. 4
Bowsher D. The management of central post-stroke pain. Postgrad Med J 1995;71:598-604.  Back to cited text no. 5


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