[Muscular-arthroscopic pain: often unappreciated]

Myoarthropathic pain, most often due to masticatory myalgia, is the major source of orofacial pain. Its 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 such 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 if pain is present on awakening. Only in a small percentage of patients the myoarthropathic pain persists and becomes chronic. The factors that determine pain chronicity are complex and most likely due to the interaction of biomedical factors - such as the persistence of peripheral nociceptive input, neuroplastic changes at spinal and supraspinal levels (cortical reorganisation)- with psychosocial factors, in addition, possibly, to a polymorphism of the catechol-o-methyltransferase gene. Patients with chronic myogenic pain 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 behavioural pain component and be tailored to the single patient based on his/her psychosocial and constitutional characteristics. The goal is not pain relief but improvement of the quality of life by teaching the patient more efficient pain coping strategies by means of behavioural and relaxation techniques. 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.