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

Häggman-Henrikson, B.; Alstergren, P.; Davidson, Thomas; Högestätt, E. D. LU ; Östlund, Olof Petter; Tranæus, Sofia; Vitols, Sigurd and List, T (2017) In Journal of Oral Rehabilitation 44(10).
Abstract

This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro-facial 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 was 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... (More)

This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro-facial 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 was 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 handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests 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. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Burning mouth syndrome, Chronic pain, Oro-facial pain, Pain management, Pharmacology, Temporomandibular joint dysfunction syndrome
in
Journal of Oral Rehabilitation
volume
44
issue
10
publisher
Wiley-Blackwell
external identifiers
  • scopus:85026466913
  • wos:000412308300009
ISSN
0305-182X
DOI
10.1111/joor.12539
language
English
LU publication?
yes
id
5910ff56-808d-487a-b937-b69b0d3cfba7
date added to LUP
2017-09-01 13:09:48
date last changed
2018-07-29 04:29:18
@article{5910ff56-808d-487a-b937-b69b0d3cfba7,
  abstract     = {<p>This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro-facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro-facial 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 was 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 handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD-joint, nine on 375 patients classified as TMD-muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD-muscle, and five on BMS were included in separate network meta-analysis. The narrative synthesis suggests 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. In conclusion, based on a limited number of studies, evidence provided with network meta-analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD-muscle pain.</p>},
  articleno    = {800-826},
  author       = {Häggman-Henrikson, B. and Alstergren, P. and Davidson, Thomas and Högestätt, E. D. and Östlund, Olof Petter and Tranæus, Sofia and Vitols, Sigurd and List, T},
  issn         = {0305-182X},
  keyword      = {Burning mouth syndrome,Chronic pain,Oro-facial pain,Pain management,Pharmacology,Temporomandibular joint dysfunction syndrome},
  language     = {eng},
  number       = {10},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Oral Rehabilitation},
  title        = {Pharmacological treatment of oro-facial pain - health technology assessment including a systematic review with network meta-analysis},
  url          = {http://dx.doi.org/10.1111/joor.12539},
  volume       = {44},
  year         = {2017},
}