The use of nonopioid drugs in management of chronic orofacial pain

Although controversial, opioid analgesics have been prescribed

for patients with chronic facial pain. Based primarily on

survey data and a few well-controlled clinical trials,

long-term opioid treatment provides adequate pain reduction in

41% to 100% of patients with chronic nonmalignant pain.

However, only 25% of chronic facial pain patients reported

adequate pain relief with chronic opioid treatment. Work,

home, and school function are generally reestablished or

maintained during chronic opioid treatment, but 25% to 38% of

patients remain dysfunctional, and one study indicated that

20% of patients became dysfunctional during treatment.


opioid treatment is associated with many transient side

effects; constipation, dizziness, nausea, vomiting, itching,

and fatigue have been reported in 5% to 42% of patients taking

opioids over 1 year. Although survey studies suggest that the

risks of addiction are low in typical patients, drug abuse

rates up to 17.3% and prescription abuse rates up to 27.6%

were reported within groups of chronic opioid users. Chronic

opioid use induces analgesic tolerance and physical

dependence, which may result in a serious abstinence syndrome

in users and children born to users. Chronic opioid use also

may induce harmful immune system changes, diminish cognitive

and motor function, and produce nociceptive hyperexcitability.

This article shows that the use of long-term opioids for

chronic facial pain is not justified based on the available

data. Despite these perceived problems, there is anecdotal

evidence that chronic facial pain patients will respond

positively to opioid analgesics. In our experience, the pain

assessment scale and a modification of the World Health

Organization’s three-step analgesic ladder, which prescribes

nonopioid analgesics, can be the starting point for the

successful management of chronic facial pain.

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