Prof. Masahiko Shimada

Prof. Shimada

ISP2012 Lecture Course Abstract:

Contemporary Orofacial Pain Management

The objective of this presentation is to introduce the Orofacial Pain Clinic of the University Hospital of Dentistry at Tokyo Medical and Dental University.

The diseases and symptoms we manage in orofacial pain clinic are pain, abnormal sensation, sensory paralysis and motor paralysis.

In particular, we manage all forms of pain in the oral and maxillofacial region, including intractable pain related to dental treatment such as neuropathic pain, atypical odontalgia, atypical facial pain and so on. 
 Prior to the treatment, the comprehensive pain history of the pain problem is an important part of the clinical assessment process. The clinician must inquire about localization, quality, intensity, duration, frequency, triggering factors, improving factors and associated signs and symptoms. A careful pain description is important since several orofacial conditions are diagnosed only upon specific pain features.

Based on physical examination and laboratory tests, diagnosis is performed.

The causes of chronic pain are generally divided into three kinds of pain; nociceptive pain, neuropathic pain and psychogenic or psychiatric pain.

The pain caused by nerve injury is difficult to be control with medications such as anti-inflammatory agents and antibiotics. Medications recommended to use for the neuropathic pain are antidepressants, calcium channel a2-d ligands, topical anesthesia, opioid agonists tramadol and so on[1]. In our clinic, many medicines such as antidepressants, anticonvulsants, and anti-anxiety medications are usually used in the treatment of these patients, together with cognitive-behavioral treatment.  The kampo, Japanese traditional medicine and acupuncture therapy were also used. In addition, we provide photo dynamic therapy and AC iontophoresis.

The transdermal drug delivery can be enhanced by chemical and physical enhancement systems; iontophoresis is one of the physical enhancement systems with electrical energy[2,3]. Two electrodes are placed apart from each other on the skin, and charged drugs are transported through the skin by the principle of electrophoresis.

Direct current (DC) is normally used in iontophoresis, but it often causes skin irritations, burns and inflammation. In order to avoid these inferiorities of DC iontophoresis, we clinically apply the alternating current (AC) iontophoresis in our department, with 4% lidocaine hydrochloride as treatment for neuropathic pain in the oral and maxillofacial region.

Atypical Odontalgia is a poorly understood chronic pain disorder that presents as a persistent pain in apparently normal teeth and adjacent oral tissues. In addition, atypical facial pain is a persistent pain in the face or intraoral region that does not fit into the diagnostic criteria associated with specific orofacial pain disorders. In orofacial pain clinic of our university hospital of dentistry, we have applied acupuncture, pharmacotherapy and psychotherapy so on for 915 patients with atypical odontalgia or atypical facial pain.

(References)

  1. RH. Dworkin, AB. et al “Recommendations for the pharmacological management of neuropathic pain: an overview and literature update,” Mayo Clin Proc., vol. 85 no. 3 Suppl., pp. S3-14, 2010.
  2. N. Higo, “Recent trend of transdermal drug delivery system development,” Yakugaku Zasshi, vol. 127, no. 4, pp. 655-62, 2007.
  3. Y. N. Kalia, A. Naik, J. Garrison, and R. H. Guy, “Iontophoretic drug delivery,” Adv Drug Deliv Rev., vol. 56, no. 5, pp. 619-658, 2004.

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