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Identifying a neurobiologic basis for drug therapy in TMDs
D J Denucci1, R A Dionne, R Dubner
1US Army Dental Corps, Walter Reed Army Medical Center, Bethesda, MD, USA.
Summary
Persistent pain alters the central nervous system, potentially explaining chronic orofacial pain and guiding new treatments. Tricyclic antidepressants and benzodiazepines show promise for specific pain types, but risks must be considered for long-term use.
Area of Science:
- Neuroscience
- Pharmacology
- Dentistry
Background:
- Persistent pain causes central nervous system (CNS) changes.
- These CNS alterations may underlie chronic orofacial pain conditions.
- Understanding these changes can inform novel therapeutic strategies.
Purpose of the Study:
- To review evidence for drug classes in managing chronic pain.
- To evaluate the efficacy and risks of medications for temporomandibular disorders (TMD).
- To guide dental professionals in therapeutic decision-making for chronic pain.
Main Methods:
- Literature review of clinical and basic research.
- Analysis of data supporting antidepressant and benzodiazepine use.
- Assessment of scientific evidence for various drug classes in pain management.
Main Results:
- Tricyclic antidepressants are supported for neurogenic or atypical pain.
- Benzodiazepines show support for musculoskeletal pain.
- Scientific evidence for many drug classes in chronic pain is equivocal.
Conclusions:
- Chronic pain induces CNS changes relevant to orofacial pain.
- Dentists must balance potential benefits of chronic drug administration against limited evidence and toxicity risks.
- Careful consideration is needed for long-term medication in managing temporomandibular disorders.