Orofacial Pain

Orofacial Pain A Guide to Medications and Management......Page 1
Contents......Page 3
Contributors......Page 5
Preface......Page 6
Orofacial PainA Guide to Medications and Management......Page 7
1.1.B Differential diagnosis and etiology of chronic orofacial pain......Page 8
1.1.E Prevalence of orofacial pain......Page 11
1.2.A Disease 1a: primary myalgia......Page 14
Etiology......Page 15
Clinical criteria......Page 16
1.3.C Open dislocations and locking problems seen in the temporomandibular joint......Page 17
Etiology......Page 18
Clinical criteria......Page 19
Etiology......Page 20
1.5.C Disease 13: tension-type headaches......Page 21
Clinical criteria......Page 22
1.6.D Disease 18: facial pain related to a chronic trigeminal neuropathy......Page 23
1.6.F Disease 20: burning mouth symptoms not related to hyposalivation......Page 24
Clinical criteria......Page 25
Clinical criteria......Page 26
1.8 Facial pain related to oral motor disorders......Page 27
1.8.C Disease 29: bruxism......Page 28
References......Page 29
2.2 What are the top 60 medications used to manage chronic orofacial pain?......Page 34
2.4 Why should we be cautious about the current literature?......Page 35
2.6 Drug 6: analgesic tramadol......Page 37
2.7 Drugs 7 and 8: analgesics acetaminophen, aspirin......Page 38
2.9 Drugs 16?18: corticosteroids methylprednisolone, triamcinolone, f.luocinonide......Page 39
2.11 Drugs 21?25: anticonvulsants carbamazepine, oxcarbazepine, lamotrigine, levetiracetam, zonisamide......Page 40
2.14 Drugs 31?34: migraine abortives sumatriptan, eletriptan, frovatriptan, rizatriptan......Page 41
2.16 Drugs 37?39: miscellaneous headache preventatives timolol, propranolol, verapamil......Page 42
2.19 Drugs 44?46: selective serotonin reuptake inhibitors escitalopram, citalopram, f.luoxetine......Page 43
2.21 Drug 50: antispasmodic cyclobenzaprine......Page 44
2.24 Drugs 54?56: benzodiazepine drugs diazepam, clonazepam, alprazolam......Page 45
2.28 Drug 60: antibacterial drugs azithromycin and others......Page 46
2.29 Conclusions: pharmacotherapeutic management of orofacial pain disorders......Page 47
References......Page 48
Indications......Page 52
Chronic musculoskeletal pain......Page 55
Chronic musculoskeletal pain......Page 56
Indications......Page 57
Indications......Page 58
Adverse effects......Page 59
Indications......Page 60
Efficacy for chronic pain......Page 61
3.4.B Preferential and selective cyclooxygenase-2 inhibitory medications......Page 62
Dosage......Page 63
3.5 Systemic Corticosteriods......Page 64
Chronic musculoskeletal pain......Page 65
3.6.B Special case: preventative analgesia......Page 66
References......Page 67
4.1.A Schedule III opioids......Page 71
Efficacy for chronic pain......Page 72
Efficacy for acute pain......Page 73
Dosage......Page 74
Dosage......Page 75
Dosage......Page 76
Adverse effects......Page 77
4.2 Chronic use of opioids for noncancer pain......Page 78
4.2.A What does the evidence suggest about opioids for noncancer pain?......Page 79
4.2.B Do opioids improve patients’ quality of life?......Page 80
4.4 Choosing an analgesic agent......Page 81
4.5.B Strategies for prevention of opioid tolerance......Page 82
4.5.D Alternate forms of opioid delivery......Page 83
Opioids for noncancer orofacial pain......Page 84
References......Page 85
5.2 Nocebo-responsive patients......Page 89
5.3 Topical pain medications: what are they and why use them?......Page 90
5.3.A Commonly used topical medications for orofacial neuropathic pain......Page 91
Efficacy of topical anesthetics for chronicorofacial pain......Page 92
Indications......Page 93
Efficacy of topical capsaicin for chronic orofacial pain......Page 94
Formulations and dosing of topical NMDAantagonists......Page 95
Efficacy of topical analgesics for chronicorofacial pain......Page 96
References......Page 97
Clinical criteria......Page 100
Other cranial neuralgias......Page 101
Clinical criteria......Page 102
Etiology......Page 103
Etiology......Page 104
Side effects and adverse drug reactions......Page 105
Efficacy for other neuropathic pain disorders......Page 106
Efficacy for other neuropathic pain disorders......Page 107
Efficacy for other neuropathic pain disorders......Page 108
Description, mechanism of action, and primary indications......Page 109
Efficacy for other neuropathic pain disorders......Page 110
Efficacy for other neuropathic pain disorders......Page 111
Efficacy for other neuropathic pain disorders......Page 112
6.3 Ten f.inal recommendations on anticonvulsants for chronic neurogenic pain......Page 113
References......Page 114
7.1 Introduction......Page 120
7.2 Muscle relaxants......Page 121
Efficacy for musculoskeletal pain associated spasm......Page 122
Efficacy for musculoskeletal pain associated spasm......Page 123
7.3 Antispasticity drugs......Page 124
Efficacy for musculoskeletal pain associated spasm......Page 125
Metabolism, side effects, and adverse drug reactions......Page 126
Efficacy for musculoskeletal pain associated spasm......Page 127
Efficacy for musculoskeletal pain associated spasm......Page 128
Recommendations for antispasticity drugs and muscle relaxants......Page 129
References......Page 130
8.1.A Serotonin versus norepinephrine as a pain inhibitor......Page 134
8.2 Antidepressants and pain suppression......Page 136
Metabolism, side effects, and adverse drug reactions......Page 137
Efficacy for other neuropathic pain disorders......Page 138
Metabolism, side effects, and adverse drug reactions......Page 139
Description, mechanism of action, and primary indications......Page 140
Description, mechanism of action, and primary indications......Page 141
Starting dose......Page 142
Efficacy for other neuropathic pain disorders......Page 143
Recommendations on psychoactive medications for chronic pain......Page 144
References......Page 145
9.3.A Beta-lactam antibiotics......Page 150
9.3.C Tetracycline-class antibiotics minocycline and doxycycline......Page 151
9.4.A Expectation fulfillment and antibiotics......Page 152
Recommendations on the use of antibiotics as a pain suppression medication......Page 153
References......Page 154
10.1.B Accuracy of diagnostic tests......Page 156
10.2.A Auriculotemporal nerve block temporomandibular joint injection......Page 157
10.2.D Occipital nerve block......Page 158
10.2.H Topical anesthetic challenge test in neuropathic pain diagnosis......Page 159
10.3 Corticosteroids and anti-inflammatory medications in orofacial pain......Page 161
10.3.A Topical NSAIDs as a diagnostic test for inflammation......Page 162
10.4.A Skeletal muscle relaxant use in orofacial pain......Page 163
10.5.A Lidocaine challenge test......Page 164
10.6.B Carabamazepine as a diagnostic test......Page 165
References......Page 166
11.1.A Acupuncture......Page 169
11.1.B Trigger-point injections......Page 170
11.1.D Occipital nerve block for headache......Page 171
11.1.F Stellate block......Page 172
11.1.H Phenol nerve block for trigeminal neuralgia......Page 173
Botulinum toxin used “on-label?......Page 174
Adverse events and side effects......Page 175
Secondary masticatory muscle spasm sometimeswith contracture......Page 176
Botulinum toxin and experimental pain in humans......Page 177
Myofascial trigger points......Page 178
Temporomandibular pain and dysfunction......Page 179
Botulinum toxin and chronic tension-type headache......Page 180
Botulinum toxin for trigeminal neuralgia......Page 181
Recommendations on using therapeutic injections, including botulinum toxin type A BoNT/A for pain and spasm......Page 182
References......Page 183
Grading the severity of oral mucositis......Page 189
12.1.C Oral mucositis consequences......Page 190
Cytokines and nuclear factor......Page 191
Diet and nutrition......Page 192
Topical anesthetics and analgesics......Page 193
Cryotherapy......Page 194
Amifostine......Page 195
12.3.B Epidemiology......Page 196
Clinical presentation......Page 197
Clinical presentation......Page 198
Causation......Page 199
Clinical presentation......Page 200
Causation......Page 201
Clinical presentation......Page 202
Avoidance of all causative and contact allergyinducing agents......Page 203
Indications and dosing......Page 204
Indications and dosing......Page 205
Adverse reactions......Page 206
Adverse reactions......Page 207
References......Page 208
13.2 Pain prevalence in cancer patients......Page 217
13.4.A Cancer-related neuropathic pain......Page 218
13.4.B Limited mouth opening secondary to muscle spasm and contracture......Page 219
Speech, masticatory, and swallowing deficits......Page 220
Intraoral sensory alterations......Page 222
13.5 Challenges in cancer pain management......Page 223
13.6.B Pharmacologic management: adjuvant analgesics......Page 224
13.6.D Anesthetic management......Page 228
13.6.G Complementary and alternative medicine......Page 229
Recommendations on the treatment of cancer-related pain and dysfunction......Page 230
References......Page 231
Diagnostic tests......Page 237
14.4.B Blink reflex testing......Page 238
14.5 Other local oral factors and burning mouth syndrome......Page 239
14.7 Psychological factors......Page 240
14.9 Current etiologic theories......Page 242
14.9.C Upregulated TRPV1 receptor theory......Page 243
14.10.A Cognitive behavioral therapy for burning mouth syndrome......Page 244
Antidepressants and antipsychotics for burningmouth syndrome......Page 245
Recommendations on the use of medications for burning mouth syndrome......Page 248
References......Page 249
Subarachnoid hemorrhage headache......Page 253
Meningitis headache......Page 254
Episodic migraine with or without aura......Page 255
Cluster headaches and other trigeminalautonomic cephalalgias......Page 256
15.1.C Other primary headaches......Page 257
Myofascial pain as a trigger for episodic headache......Page 258
15.3.A Over-the-counter medications......Page 259
15.3.D Trigger-point and other injections for migraine, ETTH, and TAC......Page 260
15.3.F Chronic abortive treatments......Page 261
15.4 Chronic daily headaches......Page 262
15.4.A Hemicrania continua......Page 263
15.5.A Withdraw symptomatic medication......Page 264
Description, mechanism of action, andprimary indications......Page 265
Efficacy for chronic daily headache......Page 266
Antihypertensives as preventative treatmentfor migraine......Page 267
Starting dose......Page 268
Efficacy for chronic daily headache......Page 269
15.5.E Complementary and alternative medicine......Page 270
Recommendations on the use of medications for treatment of chronic daily headache......Page 271
References......Page 272
How do you palpate the craniomandibular muscles?......Page 276
Widespread chronic muscle pain and fibromyalgia......Page 278
Trismus-induced secondary myogenous pain......Page 279
Stress-related muscle hypoperfusion......Page 280
How do you determine etiology?......Page 281
16.2.A Self-directed treatment......Page 282
Increased intramuscular blood flow therapy......Page 283
Stretch therapy......Page 284
16.2.B Office-based physical medicine treatment......Page 285
16.2.C Behavioral treatment for chronic muscle pain......Page 286
16.2.D Pharmacologically based treatment......Page 287
Efficacy for fibromyalgia......Page 288
Starting dose......Page 289
Efficacy for fibromyalgia......Page 290
Description, mechanism of action, and primaryindications......Page 291
Metabolism, side effects, and adverse drug reactions......Page 292
Final treatment recommendations formyogenous pain......Page 293
References......Page 294
17.1.A Prevalence of chronic trigeminal neuropathy......Page 300
Atypical odontalgia patient characteristics......Page 301
Other characteristic of trigeminal neuropathic pains......Page 302
17.2 Neuropathic pain mechanisms......Page 303
17.2.D Peripheral sensitization......Page 304
17.2.H Central inhibitory pathway deficiency......Page 305
17.3.A Lidocaine inefficacy in neuropathy......Page 306
17.3.B Anesthetic challenge test in neuropathy diagnosis......Page 307
17.4.A Clenching-induced pulpitis......Page 308
17.5 Treatment of chronic trigeminal neuropathy......Page 309
17.6 Long-term prognosis for chronic trigeminal neuropathy......Page 310
References......Page 311
18.1.C Age profiling of TMJ disease......Page 316
18.2.A Description and prevalence......Page 317
18.2.D Treatment of TMJ osteoarthritis......Page 318
Efficacy......Page 320
Indications......Page 321
Efficacy of topical medications for arthritis......Page 322
Efficacy......Page 323
18.3.A Polyjoint osteoarthritis affecting the TMJ......Page 324
18.3.C Pharmacologic treatment of polyjoint inflammatory TMJ arthritis......Page 325
Recommendations on the use of medications for arthritis of the temporomandibular joint......Page 326
References......Page 327
19.1.A Habitual tooth clenching studies in the natural environment......Page 331
19.1.D Harmfulness of habitual tooth clenching......Page 333
19.1.E Experimental tooth clenching, injected algesic agents, and jaw pain......Page 334
19.2.B Pathophysiology of bruxism......Page 335
19.2.C Actual frequency, duration, and amplitude of sleep bruxism......Page 336
Botulinum toxin type A injections for bruxism......Page 337
19.3.B Management of dystonia......Page 338
19.3.F Miscellaneous drugs for movement disorder therapy......Page 339
19.4.B Treatment of dyskinesia......Page 340
19.5 Drug-induced dystonic-type extrapyramidal reactions......Page 341
Recommendations on the management of clenching......Page 342
Four final recommendations for diagnosis and management of oromandibular dyskinesia......Page 343
References......Page 344
20.1.A Disk displacement with reduction also known as disk?condyle incoordination......Page 348
20.2 Mechanism and etiology of internal derangement......Page 349
20.2.D Joint hypermobility of the temporomandibular joint......Page 350
20.3 Diagnostic tests for temporomandibular joint internal derangements......Page 351
20.4.A Avoidance therapy for DDWR......Page 352
20.5 Treatment of DDNR......Page 353
20.5.B Anesthetic-assisted joint mobilization for DDNR......Page 354
20.5.D Arthroscopic treatment of DDNR......Page 355
20.7 Which interventions are most efficacious for DDWR and DDNR?......Page 356
References......Page 357
Appendix 
Drug list......Page 361
Index......Page 368