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

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.