[Pharmacotherapy of orofacial pain]

Pharmacotherapy of chronic orofacial pain is unsatisfactory. Here we set out to prepare a systematic review of randomized controlled clinical trials (RCTs) on pharmacotherapy of facial pain.

The diagnostic groups "temporomandibular disorders" (TMDs), "atypical facial pain", and "trigeminal neuralgia" were included. RCTs published between 1966 and August 2001 were identified by Medline search, from review articles, and from the Cochrane and Bandolier databases. The quality of the trials was judged according to established criteria. Good or excellent pain reduction or >50% pain reduction were used as endpoints for successful treatment. Numbers needed to treat (NNTs) and their 95% confidence intervals were calculated where dichotomous data were available.

Twelve studies were identified for the TMDs, 11 for trigeminal neuralgia, four for atypical facial pain. Many studies had methodological problems and small numbers of patients. There was sufficient evidence of efficacy of carbamazepin in trigeminal neuralgia, also for baclofen and lamotrigine. In the TMD studies, there was evidence of a moderate effect of muscle relaxants/tranquilizers. Two studies of atypical facial pain showed a moderate effect of antidepressants.

Apart from studies in trigeminal neuralgia, there is little evidence of efficacy of pharmacotherapy in orofacial pain. High quality studies with sufficient numbers of patients using operational definitions of disease entities are warranted.