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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    • "The closed lock is ranked, among the diagnostic criteria of reference , with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and it is classified as an advanced dysfunctional state manifesting in various clinical forms. Among the different treatments proposed in the literature [7] [8] [9] [10] [11] for this joint disease, both surgical and conservative approaches are present . At present, literature agrees on the fact that the first treatment choice should be conservative [12], but lacks in suggesting specific treatment programs. "

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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.
    Full-text · Article · Aug 2013
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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.
    Full-text · Article · Apr 2013 · The Journal of Headache and Pain
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