The current health technology assessment evaluated the efficacy of pharmacological treatments in patients with orofacial pain. Alstergren et al and colleagues conducted a systematic review including randomized controlled trials with patients (≥18 years) that suffered from chronic (≥3 months) orofacial pain and had pharmacological treatment. Patients were divided into subgroups: 1) TMD-muscle [Temporomandibular disorders (TMD) mainly associated with myalgia]; 2) TMD-joint (TMD primarily related to temporomandibular joint pain); 3) Burning mouth syndrome (BMS). The primary endpoint was to assess the pain intensity reduction after pharmacological treatment.

The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and Embase from database inception to 1 March 2017 was run to collect the data. Along with this, the search was also done, and 1,556 articles were identified. After the screening of abstracts, 182 reports were reviewed in full text, and 57 studies met the inclusion criteria. After the risk of bias assessment, 41 articles were filtered: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle, and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle and five on BMS were included in a separate network meta-analysis.

The narrative synthesis demonstrated that NSAIDs, as well as corticosteroid and hyaluronate injections, are effective treatments for TMD-joint pain. The network meta-analysis assessed clonazepam and capsaicin to be effective in reducing pain intensity in BMS. The muscle relaxant cyclobenzaprine was effective in the TMD-muscle group.

Overall, based on a limited number of studies, evidence through network meta-analysis estimated that clonazepam and capsaicin are useful in the treatment of BMS. The muscle relaxant cyclobenzaprine found to have a positive treatment effect for TMD-muscle pain.