Pharmaceutical Approaches to Orofacial Pain and Chronic Pain Conditions

Dear Colleagues,

In 2020, the International Headache Society (IHS), the International Association for the Study of Pain (IASP), and the American Association for Orofacial Pain (AAOP) collaborated to publish the first edition of the International Classification of Orofacial Pain (ICOP), which classifies orofacial pain into six different categories (Table 1). Category 1 of this classification represents acute pain, while the other categories, 2 to 6, represent chronic pain. 

Of particular relevance are myofascial orofacial pain, temporomandibular joint (TMJ) pain, burning mouth syndrome (BMS), and persistent idiopathic facial pain (PIFP). These conditions are intractable and result in chronic pain, which significantly reduces patients’ quality of life. A distinguishing feature of intractable chronic pain conditions in the orofacial region is their proclivity to co-occur with depression and anxiety, along with their higher prevalence among women. 

A variety of pharmaceutical interventions are employed to address these conditions, encompassing tricyclic antidepressants, serotonin reuptake inhibitors, anticonvulsants, antioxidants, and herbal medicines. However, the efficacy of these medications remains unproven, as there is a paucity of large-scale randomized controlled trials. 

Consequently, the level of evidence supporting drug therapy is currently inadequate. The objective of this Special Issue is to publish reviews and original articles on pharmacotherapy for chronic pain in the orofacial region. The work submitted should include the methods and limitations of pharmacotherapy for each disease, as well as the development of clinical evidence. We cordially request your contributions, including the findings from ongoing research, to enrich this special issue.  

Table1. Classification of orofacial pain according to ICOP

1. Orofacial pain attributed to disorders of dentoalveolar and anatomically related structures    

    1.1 Dental pain

    1.2 Oral mucosal, salivary gland and jaw bone pains

2. Myofascial orofacial pain

    2.1 Primary myofascial orofacial pain

    2.2 Secondary myofascial orofacial pain

3. Temporomandibular joint (TMJ) pain

    3.1 Primary temporomandibular joint pain

    3.2 Secondary temporomandibular joint pain

4. Orofacial pain attributed to lesion or disease of the cranial nerves

    4.1 Pain attributed to lesion or disease of the trigeminal nerve

    4.2 Pain attributed to lesion or disease of the glossopharyngeal nerve

5. Orofacial pains resembling presentations of primary headaches

    5.1 Orofacial migraine

    5.2 Tension-type orofacial pain

    5.3 Trigeminal autonomic orofacial pain

    5.4 Neurovascular orofacial pain

6. Idiopathic orofacial pain

    6.1 Burning mouth syndrome (BMS)

    6.2 Persistent idiopathic facial pain (PIFP)

    6.3 Persistent idiopathic dentoalveolar pain

    6.4 Constant unilateral facial pain with additional attacks (CUFPA)

※ ICOP: International Classification of Orofacial Pain

Dr. Takahiko Nagamine
Guest Editor

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• chronic orofacial pain
• pharmaceutical approach
• myofascial orofacial pain
• temporomandibular joint pain
• neurovascular orofacial pain
• idiopathic orofacial pain
• burning mouth syndrome
• persistent idiopathic facial pain
• persistent idiopathic dentoalveolar pain
• tricyclic antidepressants
• serotonin reuptake inhibitors
• anticonvulsants