Are pharmacological treatments for oro-facial pain effective?

Data sourcesElectronic searches of PubMed, the Cochrane Library, Embase, the National Health Service Economic Evaluation Database and HTA until March 2017. Also handsearched referenced in the original articles. Grey literature was not included.Study selectionRandomised controlled trials with more than ten participants with oro-facial pain duration of more than three months were sub grouped into: TMD-muscle pain (TMD-m), TMD-joint pain (TMD-j), burning mouth syndrome (BMS) and other oro-facial pain. Studies include any pharmacological treatment against another pharmacological, non-pharmacological treatment, placebo or no treatment. The primary outcome was change in pain intensity and the secondary outcome was the effect on quality of life.Data extraction and synthesisThree authors formed three review pairs that independently checked for inclusion. Four pairs of reviewers independently evaluated the risk of bias using the Swedish Agency for Health Technology Assessment and Assessment of Social Services tool. Two authors independently extracted data that were later assessed according to a modified GRADE system.ResultsForty-one studies, rated medium to low risk of bias, were included in qualitative analysis on patients with TMD-j pain (15 studies, n = 790), TMD-m pain (nine studies, n = 375), BMS (17 studies n = 868). For the TMD-j group five studies support NSAIDs and nine corticosteroid and hyaluronate injections. Eight of the nine TMD-m studies were included in a network meta-analysis (NMA), they support cyclobenzaprine, botulinum toxin injections and topical treatment with Ping-On ointment. Five of the 17 BMS studies included in a NMA support topical capsaicin and clonazepam. Of the remaining 12, five showed no effect while the remaining support alpha lipoic acid, gabapentin, clonazepam, amisulpride and SSRIs.ConclusionsBased on the results of the NMA the authors concluded that clonazepam and capsaicin are effective for BMS while cyclobenzaprine, a muscle relaxant, has a positive treatment effect on TMJ-m. Evidence from the narrative synthesis suggests NSAIDs, corticosteroid and hyaluronate injections are effective for TMD-j pain.