The management of AFP can be challenging. AFP patients are reported to consult multiple healthcare professionals in order to obtain pain relief.113 Many unnecessary invasive treatments, which may possibly aggravate the symptoms, are performed because of this.
The first step in management of carefully diagnosed AFP is patient education. The patient may need help in order to accept the fact that there is no infection or "bad tooth'' that can be easily treated or extracted. The next step is pharmacological treatment where the first choice is TCAs such as amitriptyline.60, 117[V] Treatment with TCA must be continued for several months since the analgesic effect can take weeks to occur. When pain relief has been reached, TCA treatment can be phased out, but if the pain returns it may be necessary to continue TCA treatment.121 Anticonvulsants such as gabapentin may also have some effect.101,117[V] Unfortunately, not many randomized controlled clinical trials have been performed. Surgery has been reported to cause pain aggravation and should only be performed after the confirmed presence of pathology, for example a periapical granuloma. Other types of treatments such as acupuncture, transcutaneous electric nerve stimulation (TENS), and biofeedback have been mentioned as possible treatment strategies, but the evidence in favor is scarce.121[V]
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