{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:26:04Z","timestamp":1777490764506,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2018,6,13]],"date-time":"2018-06-13T00:00:00Z","timestamp":1528848000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["141192\/2012-7"],"award-info":[{"award-number":["141192\/2012-7"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Centro de Dor do Departamento de Neurologia da Universidade de Sao Paulo, Sao Paulo, Brazil"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cephalalgia"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Persistent idiopathic facial pain is a refractory and disabling condition of unknown mechanism and etiology. It has been suggested that persistent idiopathic facial pain patients have not only peripheral generators of pain, but also central nervous system changes that would contribute to the persistence of symptoms. We hypothesized that persistent idiopathic facial pain would have changes in brain cortical excitability as measured by transcranial magnetic stimulation compared to healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-nine persistent idiopathic facial pain patients were compared to age- and sex-matched healthy controls and underwent cortical excitability measurements by transcranial magnetic stimulation applied to the cortical representation of the masseter muscle of both hemispheres. Single-pulse stimulation was used to measure the resting motor threshold and suprathreshold motor-evoked potentials. Paired-pulse stimulation was used to assess short intracortical inhibition and intracortical facilitation. Clinical pain and associated symptoms were assessed with validated tools.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Spontaneous pain was found in 27 (93.1%) and provoked pain was found in two (6.9%) persistent idiopathic facial pain patients. The motor-evoked potentials at 120% and 140% were significantly lower for both hemispheres compared to controls. Persistent idiopathic facial pain patients had lower short-interval intracortical inhibition compared with controls. These changes were correlated with some aspects of quality of life, and higher mood symptoms. These neurophysiological alterations were not influenced by analgesic medication, as similar changes were observed in patients with or without central-acting drugs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Persistent idiopathic facial pain is associated with changes in intracortical modulation involving GABAergic mechanisms, which may be related to certain aspects of the pathophysiology of this chronic pain condition. Trial registration: NTC01746355.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0333102418780426","type":"journal-article","created":{"date-parts":[[2018,6,14]],"date-time":"2018-06-14T00:53:26Z","timestamp":1528937606000},"page":"219-228","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Altered cortical excitability in persistent idiopathic facial pain"],"prefix":"10.1177","volume":"39","author":[{"given":"Ricardo","family":"Galhardoni","sequence":"first","affiliation":[{"name":"Pain Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"School of Medicine, University of City of S\u00e3o Paulo (UNICID), S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Ciampi de Andrade","sequence":"additional","affiliation":[{"name":"Pain Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Pain Center, Cancer Institute of State of S\u00e3o Paulo \u201cOctavio Frias de Oliveira\u201d, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana YT","family":"Puerta","sequence":"additional","affiliation":[{"name":"Pain Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andre R","family":"Brunoni","sequence":"additional","affiliation":[{"name":"Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruna LR","family":"Varotto","sequence":"additional","affiliation":[{"name":"Pain Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 TT","family":"de Siqueira","sequence":"additional","affiliation":[{"name":"Pain Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Dentistry Division of the Central Institute and Experimental Neurosurgery Division of the Psychiatric Institute, Clinics Hospital, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoel J","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Pain Center, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"},{"name":"Pain Center, Cancer Institute of State of S\u00e3o Paulo \u201cOctavio Frias de Oliveira\u201d, S\u00e3o Paulo, Brazil"},{"name":"Neurosurgery Division, Department of Neurology, School of Medicine, University of S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia RDT","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Pain Center, Department 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