[Principles on therapy of myoarthropathic pain]

The myoarthropathic pain is the major source of orofacial pain. The diagnosis is not always easy because the diagnostic signs are not pathognomonic and they may occur also with other pain disorders. The pain intensity fluctuates, and mild to medium intensity pain has the tendency to subside spontaneously or can be alleviated with simple, non-invasive therapies as counseling, self-control, analgesics, physiotherapy, and occlusal appliances. For most patients a combination of counseling, self-control and physiotherapy (home program) is sufficient to relieve the pain. Occlusal appliances should therefore be used only if these modalities fail or in presence of pain on awakening, ostheoarthritis, a painful discopathy, and/or a malocclusion caused by condylar remodeling secondary to ostheoarthrosis. Only in a small percentage of patients the myoarthropathic pain persists and becomes chronic. These patients need a multimodal therapy, according to the biopsychosocial pain model. In addition to the modalities just described, the treatment must address also the affective, emotional, cognitive, and behavioral pain component and be tailored to the single patient based on his/her psychosocial and constitutional characteristics. The goal is not pain relieve but improvement of the quality of life by teaching the patient more efficient pain coping strategies by means of behavioral and relaxation therapy. In addition, tricyclic antidepressants may be used in order to treat the somatic pain component caused by the neuroplastic changes that take place in the central nervous system in chronic pain conditions.