Pharmacological treatment of oro‐facial pain – health technology assessment including a systematic review with network meta‐analysis

<jats:title>Summary</jats:title><jats:p>This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro‐facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro‐facial pain. Patients were divided into subgroups: <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐muscle [temporomandibular disorders (<jats:styled-content style="fixed-case">TMD</jats:styled-content>) mainly associated with myalgia]; <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐joint (<jats:styled-content style="fixed-case">TMD</jats:styled-content> mainly associated with temporomandibular joint pain); and burning mouth syndrome (<jats:styled-content style="fixed-case">BMS</jats:styled-content>). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to <jats:styled-content style="fixed-case">GRADE</jats:styled-content>. An electronic search in PubMed, Cochrane Library, and <jats:styled-content style="fixed-case">EMBASE</jats:styled-content> from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐joint, nine on 375 patients classified as <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐muscle and 17 on 868 patients with <jats:styled-content style="fixed-case">BMS</jats:styled-content>. Of these, eight studies on <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐muscle, and five on <jats:styled-content style="fixed-case">BMS</jats:styled-content> were included in separate network meta‐analysis. The narrative synthesis suggests that <jats:styled-content style="fixed-case">NSAID</jats:styled-content>s as well as corticosteroid and hyaluronate injections are effective treatments for <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐joint pain. The network meta‐analysis showed that clonazepam and capsaicin reduced pain intensity in <jats:styled-content style="fixed-case">BMS</jats:styled-content>, and the muscle relaxant cyclobenzaprine, for the <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta‐analysis showed that clonazepam and capsaicin are effective in treatment of <jats:styled-content style="fixed-case">BMS</jats:styled-content> and that the muscle relaxant cyclobenzaprine has a positive treatment effect for <jats:styled-content style="fixed-case">TMD</jats:styled-content>‐muscle pain.</jats:p>