Beyond traditional treatments: vagal nerve stimulation for painful temporomandibular disorders.

INTRODUCTION: Chronic temporomandibular disorders (TMD) can progress to refractory chronic pain in a subset of patients, for whom standard multimodal treatments often provide limited relief. Emerging neuromodulation therapies-particularly non-invasive vagal nerve stimulation (nVNS)-suggest a potential non-pharmacologic adjunct within multimodal strategies for managing persistent symptoms. This case series explores the use of non-invasive nVNS in conjunction with a multimodal treatment strategy for managing refractory pain in patients with chronic TMD. METHODS: A retrospective review at the University of Minnesota TMD, Orofacial Pain and Dental Sleep Medicine Clinic, evaluated patients with chronic TMD pain treated with a multimodal treatment plan which included GammaCore nVNS device, by comparing their baseline data to outcomes at their most recent follow-up. RESULTS: Three patients (mean age 44.3 ± 23.3 years) with refractory TMD pain were identified as having received nVNS therapy using the GammaCore device. Treatment duration ranged from 4.6 to 18.2 months and was self-administered three to four times per day. All three patients reported improvements in pain intensity, pain-related disability, and psychosocial functioning, in the context of a multimodal treatment plan that included nVNS. DISCUSSION: Our limited clinical experience observed improvements across multiple domains relevant to patients with chronic TMD in the context of a multimodal treatment plan that included nVNS.IRB approval status: Approved STUDY00024420.