Pharmacological management in orofacial pain: a retrospective, observational study of treatment decisions and contributing factors

TL;DR

This study analyzed how medications for orofacial pain were used before and after specialist consultations, finding that treatment decisions were influenced by diagnosis, age, and psychological factors.

Contribution

The study provides empirical insights into real-world pharmacological treatment patterns and factors influencing decisions in orofacial pain management.

Findings

Pharmacological therapy use increased significantly after consultation (from 51.4% to 74.5%).

Topical NSAIDs and magnesium were the most prescribed medications post-consultation.

Myofascial pain and temporomandibular joint disorders were strongly associated with therapy changes.

Abstract

Background: The study evaluated how often pharmacological therapies
were started, modified, or discontinued after a consultation in a sample of
orofacial pain patients and identified potential factors associated with
treatment choices in the pharmacological management of orofacial pain. Methods: For this study, patient files (N = 208) originating from the daily
routine of the Orofacial Pain Unit, University of Zurich (January 2017–December
2022) were analysed. Demographics, lifestyle, pain characteristics, diagnosis,
and pharmacological therapy pre- and post- consultation with an orofacial pain
specialist were recorded. Changes in pharmacotherapy, pain perception, and
therapeutic success were assessed. Descriptive statistics, paired McNemar and
chi-square tests were conducted. Results: A total of 208 patients were
included in the study (64.4% females, mean age 45.9 years). The mean pain
intensity was 6.93 for maximum pain and 4.62 for average pain. The most common
pain locations were the face (64.3%), followed by the head (33.3%). At the
initial consultation, 51.4% of patients were already using pharmacological
therapy. The most common pre-diagnosis medications were non-steroidal
anti-inflammatory drugs (NSAIDs) (44.9%), antidepressants with pain-modulating
properties (9.3%), and magnesium (7.5%). After consultation, myofascial
orofacial pain was the most common diagnosis (50.5%). The prescription of
medications increased significantly to 74.5% (p < 0.001). Topical
NSAIDs (64.0%) and magnesium supplements (40.0%) were the most prescribed. A
significant relationship between therapy changes and diagnosis was observed,
particularly for myofascial pain (p = 0.024) and temporomandibular joint
disorders (p < 0.001). Therapy outcomes were positive for 67.0% of
the observed patients. Conclusions: Age, psychological distress, and
pain location significantly influenced pharmacological management of orofacial
pain. Pharmacological therapy differed between before and after consultation at
the Orofacial Pain Unit. Accurate diagnosis and a multidisciplinary approach to
treatment can significantly improve therapy success.

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