Pharmacological treatment of oro‐facial pain – health technology assessment including a systematic review with network meta‐analysis

Häggman‐Henrikson, Birgitta; Alstergren, Per; Davidson, Thomas; Högestätt, ED; Östlund, Pernilla; Tranæus, Sofia; Vitols, Sigurd; List, Thomas

doi:10.1111/joor.12539

Cited by 92 publications

(80 citation statements)

References 174 publications

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“…Other recent research into treatment options for the management of TMD has included orthognathic surgery, 49 TMJ lavage, 50 physiotherapy, 51,52 low-level laser therapy, 53,54 exercise therapy, 55 pharmacological treatment, 56 and acupuncture. 57 However, results are mixed and generally unconvincing.…”

Section: Alternative Treatment Options For Tmdmentioning

confidence: 99%

Oral splints for temporomandibular disorder or bruxism: a systematic review

et al. 2020

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This systematic review comprehensively summarised the best available evidence from randomised controlled trials on the effects of oral splints for temporomandibular disorders (TMD) and bruxism.There is no evidence to support the use of oral splints for either condition based on the results found.For TMD patients, sensitivity analyses were conducted to explore the effects of differences in: 1) diagnostic criteria; 2) splint types; and 3) outcome measures used and reported. There were no differences in the results based on these factors. AbstractObjectives To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism).Data sources Four databases including MEDLINE and EMBASE were searched from inception until 1 October 2018. Data selection and extractionRandomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome of pain, using random effects models in TMD patients. Data synthesisThirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all subtypes of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1,076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome. No trials measured tooth wear in patients with bruxism. There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain. ConclusionsThe very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.

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Section: Alternative Treatment Options For Tmdmentioning

confidence: 99%

Oral splints for temporomandibular disorder or bruxism: a systematic review

et al. 2020

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“…A recent network meta‐analysis of pharmacological management of BMS pain indicated that capsaicin had beneficial effects . Topical capsaicin is indeed an aetiological treatment option .…”

Section: Introductionmentioning

confidence: 99%

An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives

Imamura

Shinozaki

Okada-Ogawa

et al. 2019

J of Oral Rehabilitation

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Burning mouth syndrome (BMS) is a chronic oro-facial pain disorder of unknown cause. It is more common in peri-and post-menopausal women, and sex hormone dysregulation is believed to be an important causative factor. Psychosocial events often trigger or exacerbate symptoms, and persons with BMS appear to be predisposed towards anxiety and depression. Atrophy of small nerve fibres in the tongue epithelium has been reported, and potential neuropathic mechanisms for BMS are now widely investigated. Historically, BMS was thought to comprise endocrinological, psychosocial and neuropathic components. Neuroprotective steroids and glial cell line-derived neurotrophic factor family ligands may have pivotal roles in the peripheral mechanisms associated with atrophy of small nerve fibres. Denervation of chorda tympani nerve fibres that innervate fungiform buds leads to alternative trigeminal innervation, which results in dysgeusia and burning pain when eating hot foods. With regard to the central mechanism of BMS, depletion of neuroprotective steroids alters the brain network-related mood and pain modulation. Peripheral mechanistic studies support the use of topical clonazepam and capsaicin for the management of BMS, and some evidence supports the use of cognitive behavioural therapy. Hormone replacement therapy may address the causes of BMS, although adverse effects prevent its use as a first-line treatment. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) may have important benefits, and well-designed controlled studies are expected. Other treatment options to be investigated include brain stimulation and TSPO (translocator protein 18 kDa) ligands. K E Y W O R D Sburning mouth syndrome, central pain modulation, menopause, neuroprotective steroids | 575 IMAMURA et Al. | INTRODUC TI ONBurning mouth symptoms that occurred as secondary phenomena attributable to local conditions 1-9 were previously referred to as "secondary" burning mouth syndrome (BMS), 10 but BMS now refers only to burning symptoms not attributable to local or systemic causes. 11 After excluding such conditions, some common characteristics of BMS are important. Burning sensations are usually bilateral, and intensity fluctuates. 2 The most common site is the tip of the tongue, but pain is often noted at the lateral border of the tongue, lips and hard palate. 12 Affected persons often complain of dysgeusia, 13 which may be accompanied by subjective xerostomia. 14 Peri-and post-menopausal women are predisposed to the condition.Some patients exhibit depressive symptoms and anxiety 15-18 and may express concern regarding the presence of a malignant condition. 10,16 Psychosocial stressors can trigger or worsen pain, 15,19 while eating and drinking usually alleviate pain. 10,20 These manifestations are characteristic features of BMS and should not be excluded as secondary signs or symptoms of primary disease. Agreement on these clinical features yields important clues in understanding the underlying pathoph...

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“…Pharmacological treatment is frequently recommended for orofacial pain 42 ; however, we found only 6 (18%) RTCs using pharmacological treatments for TMD. Most of the existing literature evaluating pharmacologic treatments are observational clinical studies instead of RCTs 40,59 .…”

Section: Discussionmentioning

confidence: 63%

“…The most commonly used drugs to decrease pain and inflammatory process in joints and/or muscles are myorelaxants, non-steroidal anti-inflammatory drugs (NSAIDs), analgesics, tricyclic antidepressants (TCAs), benzodiazepines, and corticosteroids 9,39,41 . A wide range of pharmacotherapeutic agents is available; however, there is a lack of scientific evidence and no conclusive result for any of these drugs for the TMD population 6,10,39,42 .…”

Section: Pharmacological Treatmentsmentioning

confidence: 99%

Non-invasive therapies for management of temporomandibular disorders: a systematic review

Brochado

Jesus

Martins

et al. 2019

CBR

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Introduction: As a multifactorial disease, temporomandibular disorders (TMD) require a complex therapeutic approach, being noninvasive therapies the first option for most patients. The aim of this study was to perform a systematic review to analyze the most common non-invasive therapies used for TMD management. Methods: The review was done by searching electronic databases to identify controlled clinical trials related to pharmacologic and non-invasive treatments. Of all potential articles found, 35 were included in this review. Results: Low-level laser therapy (LLLT), occlusal splints (OS) and oral exercises/ behavior education (OE/BE) were the most common therapies used. LLLT showed significant results in pain and movement improvement in most studies. OS was usually combined to other therapies and resulted in improvement of pain. OE/BE showed significant results when combined with ultrasound, LLLT, and manual therapy. Conclusions: Non-invasive treatments can provide pain relief and should be prescribed before surgical procedures. LLLT was the therapy with the higher number of studies showing positive results. Based in heterogeneity of treatment protocols, diagnostic and outcomes criteria used, new well-designed randomized controlled trials (RCT) are necessary.

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Pharmacological treatment of oro‐facial pain – health technology assessment including a systematic review with network meta‐analysis

Cited by 92 publications

References 174 publications

Oral splints for temporomandibular disorder or bruxism: a systematic review

Oral splints for temporomandibular disorder or bruxism: a systematic review

An updated review on pathophysiology and management of burning mouth syndrome with endocrinological, psychological and neuropathic perspectives

Non-invasive therapies for management of temporomandibular disorders: a systematic review

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