Medication Treatment Efficacy and Chronic Orofacial Pain.

Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are three medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use, plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), three prophylactic medications have reasonable therapeutic efficacy (beta-blockers, tricyclic antidepressants, and anti epileptic drugs). The three Food and Drug Administration-approved drugs for fibro-myalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteoarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy, and when gastritis contraindicates them, corticosteriod injections are helpful.