<p>Pharmacotherapeutic outcomes in atypical odontalgia: determinants of pain relief</p>

Abstract

Objectives There has been considerable research which has focused on clarifying the origin of pain in patients with atypical odontalgia (AO), also known as “idiopathic toothache”, and on identifying effective treatment, but there has been limited success so far. In this study, we assessed the outcomes of treatment and attempted to identify factors that could account for pain remission in patients with AO. Patients and methods Data for 165 patients diagnosed with AO from June 2015 to August 2017 were retrospectively reviewed. The patients’ sex, age, duration of pain, and psychiatric history were collected, along with information on pain intensity, depressive status, and catastrophizing scores. Responses at 4 and 16 weeks from the start of treatment were observed. The associations between potentially associated factors and outcome were investigated using Bayesian model averaging. Results A 30% reduction in pain was reported by 38 patients (46.3%) at 4 weeks and by 54 patients (65.9%) at 16 weeks. The pain intensity decreased as the depression and catastrophizing score improved; all of the changes were statistically significant ( P <0.001). Four elements, that is, patient sex, depression score at baseline, pain score at 4 weeks, and change in the catastrophizing score, explained 52.5% of the variation in final outcome between individual patients. Conclusion Our findings confirm the efficacy of tricyclic antidepressants (TCAs) as a treatment for AO and indicate that other medications, especially aripiprazole used in combination with a TCA, may be useful. A considerable number of patients, especially women, those with lower levels of depression at baseline, and those who responded to 4 weeks of treatment, achieved pain relief.

Pharmacological Approach to Atypical Odontalgia Patients: A Systematic Review of Case Reports

“…This study also found the use of dopamine partial agonists (DPA), such as aripiprazole, effective for AO treatment. These findings are in accordance with the results of the research conducted by Tu et al, in which aripiprazole was used, both as a single dose or combined with TCA [7]. High dopamine tonic activities can increase pain due to the reduced release of μopioid [43].…”

“…High dopamine tonic activities can increase pain due to the reduced release of μopioid [43]. Therefore, aripiprazole, as a dopamine stabilization agent, can reduce pain intensity in patients diagnosed with AO [7].…”

“…As a part of chronic orofacial pain, AO is also known to have a negative impact on the quality of life and daily activities of the patient [7,8]. This is due to pain and dysfunction complaints during oral activities, such as chewing, talking, opening or closing the jaw, and brushing teeth [9].…”

Dental extraction and full mouth root canal therapy in a patient with atypical odontalgia: Report of invasive malpractice

“…As antidepressants are reported to be effective in the treatment of AO [1,3,2], the patient underwent medical treatment according to a combination therapy with fluoxetine and clonazepam suggested by Mortazavi et al, [2] Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant agent and clonazepam is a benzodiazepine derivative with anticonvulsant, muscle relaxant, analgesic, and anxiolytic properties [2]. Some other medications used for AO include gabapentin, tricyclic anti-depressants (TCAs), topical anesthetics, and opioids [13,14].…”

A review of persistent idiopathic dentoalveolar pain (formerly PDAP/Atypical odontalgia)

“…Unfortunately, there are very few medications formulated to specifically treat PIDP. As such, the first line medication for management of PIDP is a tricyclic antidepressant such as amitriptyline, which has been reported to successfully produce a 30% pain reduction in 65% of patients after 16 weeks 32 . SNRI (serotonin-norepinephrine reuptake inhibitors) such as milnacipran and duloxetine have also seen use.…”