Directed by Dr. Alexandre F. DaSilva, H.O.P.E. (Headache & Orofacial Pain Effort) is a multidisciplinary collaborative effort to investigate the brain as a research and therapeutic target for chronic trigeminal pain disorders, including primary headaches (e.g. migraine), TMJD and trigeminal neuropathic pain.
The fact that many therapeutic modalities for chronic pain, which focus on peripheral mechanisms, do not provide relief for treatment-resistant patients raises the possibility that the cause for the chronicity of these debilitating disorders may lie in the brain itself. One hypothesis is that functional and structural dysfunction of specific cortical areas (e.g. SI, DLPFC), even at molecular level (e.g. opioidergic and gabanergic mechanisms), may be responsible for the persistence and intensification of the pain suffering.
Together with collaborators from University of Michigan and other academic institutions, we use state-of-the-art neuroimaging techniques (fMRI, PET, MRS, DTI, and MRI-based morphometry) to study neuroplasticity, and to investigate novel therapeutic approaches and mechanisms (e.g. non-invasive brain stimulation) in chronic trigeminal pain disorders.
Director and Founder, Headache & Orofacial Pain Effort (H.O.P.E.) Lab
Co-Director, fNIRS Laboratory, Center for Human Growth & Development
Assistant Professor, Biologic & Materials Sciences, School of Dentistry
Dr. Alexandre DaSilva is an Assistant Professor at the Biologic & Materials Sciences Department at the University of Michigan Dental School. He has received his Doctorate in Medical Science (DMSc) degree in Oral Biology with clinical training in trigeminal pain at Harvard University. His thesis subject was on somatotopic (fMRI) activation in the human trigeminal pain pathway. This training was followed by a post-doctoral fellowship on migraine neuroimaging at the Martinos Center for Biomedical Imaging, Massachusetts General Hospital, to investigate subcortical and cortical neuroplasticity in migraine patients. He was also an Instructor in the Psychiatric Department at Harvard University/McLean Hospital, as well as, an Assistant Clinical Investigator at the Forsyth Institute in Boston. During his training, he collaborated with his colleagues on innovative neuroimaging and non-invasive brain stimulation projects for chronic TMJD, trigeminal neuropathic pain and migraine.
He is currently the Director of H.O.P.E. (Headache & Orofacial Pain Effort), which is a multidisciplinary collaborative effort to investigate the brain as a research and therapeutic target for chronic trigeminal pain disorders. The fact that many therapeutic modalities for chronic pain, which focus on peripheral mechanisms, do not provide relief for treatment-resistant patients raises the possibility that the cause for the chronicity of these debilitating disorders may lie in the brain itself. One hypothesis is that functional and structural dysfunction of specific cortical areas (e.g. SI, DLPFC), even at a molecular level (e.g. opioidergic and gabanergic mechanisms), may be responsible for the persistence and intensification of the pain suffering. Together with collaborators from the University of Michigan and other academic institutions, we use state-of-the-art neuroimaging techniques (fMRI, PET, MRS, DTI, and MRI-based morphometry) to study neuroplasticity, and to investigate novel therapeutic approaches and mechanisms in chronic trigeminal pain disorders, including TMD the main focus.
The most recent publications are reported below via PubMed search.
Changes in resting state functional connectivity after repetitive transcranial direct current stimulation applied to motor cortex in fibromyalgia patients.
Arthritis Res Ther. 2016;18(1):40
Authors: Cummiford CM, Nascimento TD, Foerster BR, Clauw DJ, Zubieta JK, Harris RE, DaSilva AF
BACKGROUND: Fibromyalgia (FM) is a chronic, centralized pain condition characterized by alterations in the functional, chemical, and structural brain networks responsible for sensory and mood processing. Transcranial direct current stimulation (tDCS) has emerged as a potential treatment for FM. tDCS can alter functional connectivity (FC) in brain regions underneath and distant to the stimulating electrode, although the analgesic mechanisms of repetitive tDCS remain unknown. The aim of this study was to investigate how a clinically relevant schedule of tDCS sessions alters resting state FC and how these changes might relate to clinical pain.
METHODS: Resting state functional magnetic resonance imaging data were collected from 12 patients with FM at baseline, after 5 days of sham treatment, and after 5 days of real tDCS with the anode over the left primary motor cortex (M1) and the cathode over the right supraorbital cortex. Seed to whole-brain FC analyses were performed with seed regions placed in bilateral M1, primary somatosensory cortices (S1), ventral lateral (VL) and ventral posterolateral (VPL) thalami, and periaqueductal gray (PAG).
RESULTS: Stronger baseline FC between M1-VL thalamus, S1-anterior insula, and VL thalamus-PAG predicted greater analgesia after sham and real tDCS. Sham treatment (compared with baseline) reduced FC between the VPL thalamus, S1, and the amygdala. Real tDCS (compared with sham treatment) reduced FC between the VL thalamus, medial prefrontal, and supplementary motor cortices. Interestingly, decreased FC between the VL/VPL thalamus and posterior insula, M1, and S1 correlated with reductions in clinical pain after both sham and active treatments.
CONCLUSIONS: These results suggest that while there may be a placebo response common to both sham and real tDCS, repetitive M1 tDCS causes distinct changes in FC that last beyond the stimulation period and may produce analgesia by altering thalamic connectivity.
PMID: 26842987 [PubMed - in process]
Project: Neuroimaging of Dentin Hypersensitivity: An fNIRS Study
Project: Neuroimaging and Neuromodulation of Orofacial Cancer Pain
Project: Neuromodulation in Chronic TMD Pain
Currently at Harvard University Part-Time Faculty in Orthodontics & Private Practice
Alumni: Postdoctoral Trainees & Residents
|2011 - 2012||Ilkka Martikaninen MD, PhD
Project: Neuroimaging in Trigeminal pain
|2009 - 2012||Marcos DosSantos MSc, DDS, PhD
Project: Neuroimaging and Neurostimulation in Orofacial Pain
Currently: Tenured Faculty Member, Universidade Federal do Rio de Janeiro
Alumni: Research Assistants & Dental Students
|2013 - 2014||Mary-Catherine Bender
Currently: DDS Program, University of Michigan
|2013 - 2014||Sarah Lucas
Currently: Optometry Program, Indiana University
|2012 - 2013||Hendrik Van Holsbeck
Currently: DDS Program, University of Michigan
|2012 - 2013||JJ Ubonwan Sae-Ung, DDS
Currently: Lecturer Oral Surgery Clinic, University of Michigan
|2012 - 2013||Misty DeBoer
Currently: Communications Coordinator, Institute for Central American Development Studies (ICADS), Costa Rica
|2010 - 2011||Nellie Kippley
Currently: Nephrology Physician Assistant, CentraCare Health System, MN
|2009 - 2010||Alexandra Martella, DDS
Currently: Endodontic Resident at University of Illinois Chicago
The animation above shows where on the skull scientists placed the non-invasive electrodes, and where the current flowed through the brain. The areas in blue show low current. The areas in red show high current, and they found that this high current reached key pain processing structures deeper within the brain
Plus coverage in: Metro, Slate, Financial Express, NBC, CBS, BBC, Scientific American Mind Magazine, Reuters, Forbes, Washington Post, The Guardian, The Telegraph, CBC, Medical News Today, Delhi Daily News, Free Press Journal, The News International, RedOrbit, Detroit Free Press, UPI, and others.
2014 WWJ Newsradio CBS radio affiliated: “Migraine twitter” by Sean Lee
2001 Globo Reporter (Brazil): “The Brain with Pain.”
Office: Biologic & Materials Sciences
School of Dentistry
1011 N. University Ave., Room 1014A
Ann Arbor, MI 48109-1078
H.O.P.E. Lab: The Molecular & Behavioral Neuroscience Institute (MBNI)
205 Zina Pitcher Pl, Room 1026
Ann Arbor, MI 48109-5720
Tel: 734 615-3807
Fax: 734 763-3453