Pharmacological Health Technology Assessment of Orofacial Pain through Systematic Review and Network Meta-Analysis

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Pharmacological Health Technology Assessment of Orofacial Pain through Systematic Review and Network Meta-Analysis

Orofacial pain is one of the most frequent and debilitating pain conditions involving trigeminal system (face, head, temporomandibular joint, masticatory musculature, and associated structures). These pain conditions are known to significantly affect patient’s overall quality of life. The treatment of orofacial pain involves specific pharmacological and non-pharmacological interventions.

In this systematic review, evaluation of a health technology assessment was done to figure out pharmacological treatment efficacy among patients with orofacial pain. An electronic search was done to select original research articles. The databases for literature search involved Embase, PubMed and Cochrane Library and articles published from 1 March 2017 were combined with 1,556 hand-search items. Randomized controlled trials which had a record of patients ≥18 years with chronic (≥3 months) orofacial pain pharmacological treatment were included in the review. After abstracts screening,182 articles were analyzed in full text.

Out of these 182, only 57 studies met with the inclusion criteria, of which only 41 articles remained for further evaluation after the risk of bias estimation. The whole study divided into three groups:  TMD-joint (Temporomandibular disorders (TMD) related to temporomandibular joint pain); Burning mouth syndrome (BMS) and TMD-muscle [TMD related with myalgia]. Of all 41 articles, 17 articles comprised 868 patients with BMS, 15 involved 790 patients with TMD-joint, and 9 involved 375 patients with TMD-muscle. From these studies, five on BMS and eight on TMD-muscle were engaged in separate network meta-analysis. Further, the primary outcome of the investigation was pain intensity that was reduced after the pharmacological treatment.

During the evaluation, a narrative synthesis approach was made which suggested that corticosteroids, NSAIDs, as well as hyaluronate injections, exhibited an excellent effect for TMD-joint pain. Further, the network meta-analysis demonstrated that capsaicin and clonazepam can also reduce the pain among patients with BMS and cyclobenzaprine, a muscle relaxant decreased pain among patients with TMD-joint pain.

Therefore, from the whole analysis based on limited data and evidence provided with network meta-analysis, it can be concluded that clonazepam and capsaicin on BMS and cyclobenzaprine on TMD-muscle pain, have a great pain reducing effect.


J Oral Rehabil. 2017 Jun 27

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Original title of article:

Pharmacological treatment of orofacial pain - Health Technology Assessment including a systematic review with network meta-analysis


Häggman-Henrikson B; et al.

Therapeutic, Orofacial pain, Chronic, Randomized controlled, Systematic review, Meta-analysis, Efficacy
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