The chemotherapeutic management of chronic and persistent orofacial pain

The use of medication in chronic orofacial pain is not without risk. It is important to be vigilant regarding side effects, including abuse. The treatment of chronic pain can be frustrating and confusing because most patients with pain experience remissions and relapses. The initial report of reduced pain by the patient to any of the treatments that have been attempted may lead to false optimism about the nature of the condition or the potential long-term response to medication. With time the patient may report a reduced response to the medication and suggest either a higher dose or a different medication. In such patients it is important to reexamine the original differential diagnosis. When in doubt, additional consultation with pain centers, other clinicians with experience in managing patients with chronic pain, and consultation with the patient's physician may be needed. If the patient develops an abnormal personality or behavioral profile, referral to a specialist in behavioral medicine may also be needed. The treatment of chronic benign pain should proceed as planned, being careful not to place the patient in an "at-risk position" regarding medications and their effects or side effects.