Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 83(1, Supplement): 134-142. January 1997.
Summary: This article on pharmacologic treatments for temporomandibular disorders is from a special supplement issue on the NIH Technology Assessment Conference on the management of temporomandibular disorders (TMDs), held in April 1996. The author notes that drugs are widely used in the management of acute and chronic orofacial pain. Whereas the use of analgesics for acute orofacial pain is well documented, the use of a broad spectrum of drugs for chronic pain is based on few studies. In the absence of data supporting a therapeutic benefit for a drug used chronically for pain, toxicity associated with the drug can still occur. It is critical, therefore, to assess the balance between therapeutic benefit and safety. The author reviews current evidence supporting the use of several drug classes for TMD and identifies therapeutic controversies in need of further research. Drug classes discussed include nonopioid analgesics, opioids, corticosteroids, antidepressants, benzodiazepines, and muscle relaxants. Assuming that a reliable differential diagnosis can be performed, pain with a neuropathic or atypical component would recommend a trial with a tricyclic antidepressant. Pain of musculoskeletal origin is probably best managed by physical medicine procedures, possibly supplemented with a short trial of a benzodiazepine or an NSAID. Patients with manifestations of psychosocial dysfunction may not benefit from drug therapy aimed at pain and should be considered as candidates for physical medicine modalities and behavioral methods. 3 figures. 1 table. 55 references. (AA-M).
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