Orofacial pain: diagnostic and therapeutic topicals, nerve blocks and trigger point injection

Pain is the prime motivator factor for seeking emergency healthcare services. It results in enormous expenditure every year in terms of lost work, utilization of health care resources, medications and affects quality of life. When the pain occurs in and around the mouth, the physician/ dentist is the first person that the patients seek help. Although, rapid strides have been made in combating acute orofacial pain, chronic pain, acute exacerbations of chronic orofacial pain still seem to be a challenge.

Orofacial pain deals with the assessment, diagnosis and treatment of pain conditions and dysfunction affecting face or oral cavity. The field of orofacial pain includes pain conditions that are associated with the hard and soft tissues of the head, face, neck, jaw, mouth and other intra oral structures (1). Often physicians in emergency services and dentists face diagnostic dilemmas because of the complexity of orofacial structures and perplexing referral patterns. In several instances, these patients are neglected, misdiagnosed and are passed on from one healthcare professional to another. Efficacious treatment requires comprehensive diagnostic evaluation, clear diagnosis and scientific evidence-based treatment plan.

The International Classification of Orofacial Pain (ICOP) was proposed in 2020 and has been a breakthrough in offering diagnostic criteria for diagnosis of various acute and chronic orofacial pain conditions. The ICOP has standardized and revolutionized diagnostic criteria of orofacial pain conditions for diagnostic and research purposes (2). The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) continues to be the most validated and widely accepted diagnostic classification for Temporomandibular Disorders (3).

Management of orofacial pain conditions may include pharmacological management, home care, physiotherapy, alternative, complimentary management, interventional and rarely surgical procedures. Local anesthetics are the one of the most powerful chairside tools that are used in diagnosis and management of orofacial pain conditions. They offer immense insights into possible etiopathogenesis, help localize the source/site of pain and offer therapeutic options in form of nerve blocks and trigger point injections. Additionally, both nerve blocks, trigger point injections may provide immediate pain relief and are invaluable tools for emergency care physicians. Immediate relief of pain may ensure patient satisfaction and compliance. Topical medications have also been found to be beneficial in cases of mild/moderate orofacial pain and can reduce the dose of systemic medications utilized for severe orofacial pain. They have additional benefits such as immediate pain relief, no significant side effects and relatively safe therapeutic options in elderly and medically complex cases (4).

The series integrates current thrusts in multiple disciplines of medicine, dentistry, documented scientific literature to provide clinicians with principles, techniques of evaluation and management of early and acute, chronic and acute exacerbations of pain conditions in the orofacial region.

Mythili Kalladka

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Oral and Maxillofacial Anesthesia for the series “Orofacial Pain: Diagnostic and Therapeutic Topicals, Nerve Blocks and Trigger Point Injection”. The article did not undergo external peer review.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://joma.amegroups.com/article/view/10.21037/joma-23-42/coif). The series “Orofacial Pain: Diagnostic and Therapeutic Topicals, Nerve Blocks and Trigger Point Injection” was commissioned by the editorial office without any funding or sponsorship. M.K. serves as the unpaid Executive Editor-in-Chief of Journal of Oral and Maxillofacial Anesthesia from July 2023 to June 2025 and served as the unpaid Guest Editor of the series. The author has no other conflicts of interest to declare.

Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Available online: https://aaop.org. Accessed November 1, 2023.
2. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia 2020;40:129-221.
3. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache 2014;28:6-27. [Crossref] [PubMed]
4. Heir G, Karolchek S, Kalladka M, et al. Use of topical medication in orofacial neuropathic pain: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:466-9. [Crossref] [PubMed]