Pharmacological interventions for pain in patients with temporomandibular disorders

School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, Scotland, UK, AB25 2ZD.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 10/2010; 10(10):CD004715. DOI: 10.1002/14651858.CD004715.pub2
Source: PubMed


Temporomandibular disorders (TMD) are disorders that affect the joint between the temporal bone on the side of the head and the mandibular (jaw) bone of the face, and the associated muscles. Pain is the defining feature of TMD and the primary reason for seeking care. TMD may also involve joint noises or restricted jaw function or both. Different medicines are used to treat pain due to temporomandibular disorders (TMD). These include simple painkillers (analgesics) and medicines which reduce inflammation and treat pain (for example, non-steroidal anti-inflammatory drugs, corticosteroids). Medicines (called benzodiazepines) are sometimes used to reduce tension and spasm in the muscles affected by TMD. In addition, some antidepressant medicines (called tricyclic antidepressants) are used in low doses to help patients with TMD and are thought to be effective because they reduce muscle tension in patients who grind their teeth. This review found that there was not enough evidence to decide which medicines are effective in reducing pain due to chronic TMD.

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Available from: Margaret (Mags) C Watson,
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    • "(Datenstand: September 2011) und Mujakperuo et al. [8] (Datenstand: September 2010). In der Sparte ,,Other Reviews'' konnte eine Übersicht von List et al. [10] — Datenstand: Oktober 2000 — als teilweise relevant beurteilt werden. "
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    ABSTRACT: Pharmacological interventions in temporomandibular joint (TMJ) pain differ from corresponding therapeutic interventions of jaw muscle (myofascial) pain. An actual systematic literature search lists and evaluates available articles on randomised controlled trials for treatment of arthralgia of the TMJ. On the basis of the few available trial reports, non-steroidal anti-inflammatory drugs (NSAIDs) seem to be effective, but side effects and drug interactions need to be considered. In relation to other therapeutic modalities, the rapidity of the onset of action of NSAIDs seems to be different, and the extension of side effects can be varied or reduced by changing the application route (oral versus topical). Palmitoylethanolamide (PEA) as dietary supplement for special medical purposes can apparently evoke positive therapeutic effects in TMJ arthralgia which need to be analysed in further studies.
    08/2013; 107(4-5):302-8. DOI:10.1016/j.zefq.2012.12.003
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    • "Therapies range from soft diet, splint, and physiotherapy, drugs, psychological and surgical. Many of these have been evaluated in RCTs and there are several systematic reviews [65-67] but the quality of many of the trials is poor. A variety of surgical procedures including arthocentesis and arthroscopy can be used but they should only be used if there are functional signs [68]. "
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    ABSTRACT: Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
    The Journal of Headache and Pain 04/2013; 14(1):37. DOI:10.1186/1129-2377-14-37 · 2.80 Impact Factor
    • "Many of the surgical and dental therapies suggested for TMJ disorders have no scientifically proven effect;[67] therefore, pharmacotherapy is the primary intervention in patients with TMJ disorder.[6] Although pharmacotherapy is not curative for these patients it helps them to manage dysfunction and discomfort caused by such a chronic disorder.[7] Despite the wide range of pharmacotherapeutic agents used for TMJ disorder, there is still controversy regarding the treatment of choice for these patients.[67] "
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    ABSTRACT: Objective: Ibuprofen – a non-steroidal anti-inflammatory drug (NSAID)- and glucosamine sulfate – a natural compound and a food supplement- are two therapeutic agents which have been widely used for treatment of patients with temporomandibular joint (TMJ) disorders. This study was aimed to compare the effectiveness and safety of these two medications in the treatment of patients suffering from TMJ disorders. Methods: After obtaining informed consent, 60 patients were randomly allocated to two groups. Patients with painful TMJ, TMJ crepitation or limitation of mouth opening entered the study. Exclusion criteria were history of depressive disorders, cardiovascular disease, musculoskeletal disorders, asthma, gastrointestinal problems, kidney or liver dysfunction or diabetes mellitus, dental diseases needing ongoing treatment; taking aspirin or warfarin, or concomitant treatment of TMJ disorder with other agents or methods. Thirty patients were treated with ibuprofen 400 mg twice a day, (mean age 27.12 ± 10.83 years) and 30 patients (mean age 26.60 ± 10) were treated with glucosamine sulfate 1500 mg daily. Patients were visited 30, 60 and 90 days after starting the treatment, pain and mandibular opening were checked and compared within and between two groups. Findings: Comparing with baseline measures, both groups had significantly improved post-treatment pain (P < 0.0001 for both groups) and mandibular opening (P value: 0.001 for glucosamine sulfate and 0.03 for ibuprofen). Post treatment pain and mandibular opening showed significantly more improvement in the glucosamine treated patients (P < 0.0001 and 0.01 respectively). Rate of adverse events was significantly lower in the P value glucosamine sulfate group (P < 0.0001). Conclusion: This investigation demonstrated that comparing with a commonly prescribed NSAID – ibuprofen-, glucosamine sulfate is a more effective and safer therapeutic agent for treatment of patients with TMJ degenerative join disorder.
    Journal of Pharmacy Practice and Research 03/2013; 2(1):34-9. DOI:10.4103/2279-042X.114087
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