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Evidence from NMA suggests that
use of NSAIDs, corticosteroid and hyaluronate injections should be considered
for TMD-j pain, due to their efficacy in pain management.
According to a systematic review and meta-analysis published in the Journal of Oral Rehabilitation, Clonazepam and capsaicin are effective for burning mouth syndrome (BMS) and cyclobenzaprine has a positive effect on temporomandibular joint disorders (TMD-J).
Orofacial pain is the most
prevalent and debilitating disorder involving the head, face, and neck. This
complex disorder represents a challenge to the clinician because this pain can
arise from many sources. There are three different divisions of oro-facial
pain: temporomandibular muscle disorders (TMDmuscle), temporomandibular joint
disorders (TMD-J) and burning mouth syndrome (BMS). Out of these three, BMS is
most common in post-menopausal women, with prevalence rates in the general
population varying between 0.1%-3.9%2 with a recent population-based study
showing a prevalence of 0.11%.
Debra Fischoff et al conducted
this systemic review to evaluate the efficacy of various pharmacologic
treatments for three different categories of oro-facial pain. In this trial,
the authors included more than ten patients with orofacial pain, and they were
divided into following subgroups: TMD-muscle pain (TMD-m), TMD-joint pain
(TMD-j), burning mouth syndrome (BMS) and other oro-facial pain. The author
evaluates the change in intensity of pain and their effect on the quality of
life as a primary and secondary outcome respectively.
The data were evaluated by three authors independently. Swedish Agency for Health Technology Assessment and Assessment of Social Services tool was used to evaluate the risk of bias. Data were extracted according to a modified GRADE system by two authors.
Out of all included studies, 41
were included in patients with TMD-j pain (15 studies, n = 790), TMD-m pain
(nine studies, n = 375), BMS (17 studies n = 868) and rated as medium to low
risk of bias. For the TMD-j group, five and nine studies support NSAIDs and
corticosteroid injections respectively. Eight of the nine TMD-m studies were
included in a network meta-analysis (NMA), and the use of cyclobenzaprine,
botulinum toxin injections and topical treatment with Ping-On ointment was
supported. Five of the 17 BMS studies included in an NMA support topical
capsaicin and clonazepam. Of the remaining 12, five showed no effect while the
remaining support alpha-lipoic acid, gabapentin, clonazepam, amisulpride, and
SSRIs. The authors supported the use of NSAIDs, and corticosteroid and
hyaluronate injections for orofacial pain management.
Evid Based Dent.
Are pharmacological treatments for oro-facial pain effective?
Debra Fischoff et al.
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