Burning mouth syndrome (BMS) is neuropathic disorder diagnosed with symptoms of oral mucosal burning. There is the number of pharmacological treatments is available for relieving facial-pain, but it is essential to know which treatment is effective. Therefore, in this review, the author showed that clonazepam and capsaicin are effective for BMS while cyclobenzaprine, a muscle relaxant, has a positive treatment effect on the joint pain. 

To estimate the efficacy of pharmacological treatments for oro-facial pain.

The Cochrane Library, the National Health Service Economic Evaluation Database, PubMed, HTA, and Embase were searched till March 2017. A hand search of original articles was also done.  Grey literature was not added. The analysis involved the randomised controlled trials which comprised more than ten participants having oro-facial pain for more than three months and categorised as TMD-joint pain (TMD-j), burning mouth syndrome (BMS), TMD-muscle pain (TMD-m), and other oro-facial pain. The studies may involve the comparison of any pharmacological treatment with non-pharmacological treatment, another pharmacological, no treatment, or placebo. Change in the pain intensity was taken as primary endpoint and impact on the quality of life considered as the secondary endpoint. Three review pairs were made by the three authors that checked for inclusion independently. The risk of bias was assessed separately by four pairs of reviewers using the Assessment of Social Services tool and Swedish Agency for Health Technology Assessment. The data extraction also was done independently by two authors and evaluated as per a modified GRADE system.

A total of forty-one studies involved in qualitative analysis on patients with BMS, TMD-j pain, and TMD-m pain found to have medium to low risk of bias. For the TMD-j group, nine studies support Corticosteroid and Hyaluronate injections and five support NSAIDs. A network meta-analysis included eight of the nine TMD-m studies that support Botulinum toxin injections, topical treatment with Ping-On ointment, and Cyclobenzaprine. Out of 17 BMS studies, five involved in a NMA support topical capsaicin and clonazepam. Out of left 12 studies, eight studies support Clonazepam, SSRIs, Alpha lipoic acid, Amisulpride, and Gabapentin, whereas five exhibited no effect. 

Capsaicin and Clonazepam are efficacious for BMS while cyclobenzaprine shows a positive impact on TMJ-m. For TMD-j pain, Corticosteroid, Hyaluronate injections, and NSAIDs show significant efficacy.