Pharmacological Treatment of Orofacial Pain-Health Technology Assessment including a Systematic Review with Network Meta-Analysis

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Pharmacological Treatment of Orofacial Pain-Health Technology Assessment including a Systematic Review with Network Meta-Analysis
Key Take-Away: 

Clonazepam, capsaicin, and cyclobenzaprine can generate useful outcomes in the treatment of Burning mouth syndrome and Temporomandibular disorders muscle group respectively.

Orofacial pain is a common problem which includes any pain felt in the mouth, jaws, and the face. 

ABSTRACT: 
Background: 

Orofacial pain is a common problem which includes any pain felt in the mouth, jaws, and the face.

Antiepileptic drugs, such as gabapentin and valproic acid, in combination with tricyclic antidepressants such as amitriptyline are generally recommended for the treatment of orofacial pain. This health technology assessment evaluated the efficacy of pharmacological treatment in patients with orofacial pain.

 

Methods: 

Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) orofacial pain. Patients were divided into subgroups: TMD-muscle [Temporomandibular disorders (TMD) mainly associated with myalgia]; TMD-joint (TMD mainly associated with temporomandibular joint pain); and Burning mouth syndrome (BMS).

The primary outcome measure was the assessment of 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 combined with a hand search identified 1,556 articles. After the screening of abstracts, 182 articles were reviewed in full text, and 57 studies met the inclusion criteria. After the risk of bias assessment, 41 articles were finally filtered: 15 studies on 790 patients classified as TMD-joint, 9 on 375 patients classified as TMD-muscle, and 17 on 868 patients with BMS. Of these, 8 studies on TMD-muscle and 5 on BMS were included in a separate network meta-analysis.

Results: 

The narrative synthesis suggested that NSAIDs, as well as corticosteroid and hyaluronate injections, are effective treatments for TMD-joint pain.

The network meta-analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD-muscle group.

Conclusion: 

Based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in the treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

 

Source:

J Oral Rehabil. 2017 Jun 27. doi: 10.1111/joor.12539

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/28653747

The original title of the article:

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

Authors

Häggman-Henrikson B at al.

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