This Page Intentionally Left Blank - Int Medical

380
Temporomandibular disorders
NATHANAEL WOOD AND JOHN H. BURTON
n Agents
n NSAIDs
n Opioids
n Amitriptyline
n Glucosamine sulfate
n Benzodiazepines
n Muscle relaxants
n Evidence
Tricyclic antidepressants (TCAs), NSAIDs, anxiolytic agents, and muscle
relaxants are the most common agents used to treat temporomandibular
disorder (TMD) and its most common manifestation, temporomandibular
joint (TMJ) pain. A National Institutes of Health conference on TMD, as well
as recent literature reviews, conclude that the current body of evidence does
not support any one drug as superior in the management of TMD. 1–3 Acute
care analgesic regimens are typically combined with soft diet and habit
reversal (e.g. gum-chewing cessation).
Although NSAIDs are the analgesic mainstay for acute TMD, trial evidence
supporting use of this class is mixed. Two RCTs demonstrate no therapeutic
advantage of oral NSAIDs over placebo for treatment of TMD. The first of
these RCTs found therapeutic equivalence between ibuprofen (2400 mg PO
daily) and placebo after four weeks of treatment for myofacial pain. 4 The
second trial also found no benefit for NSAIDs, showing no advantage of
piroxicam (20 mg PO daily) over placebo for TMD. 5 Another study, focusing
on patients with chronic TMD (over 90 days in duration), found that NSAIDs
added no pain relief over that achieved by benzodiazepines (see below). 4
An RCT in patients with clinical TMD (and lacking radiographic evidence of
osteoarthritis) demonstrated that ampiroxicam (27 mg PO daily), combined