# 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.

## Key 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.