Analgesics and Adjuvants for the Management of Orofacial Pain Across Age Groups

Abstract

The orofacial region is critical for survival due to its role in eating and drinking, identity and self-esteem, and communication and expressions of emotion. Orofacial pain is comparatively less tolerated than pain in other body areas due to its disproportionately large representation in the cerebral cortex. The individual with severe orofacial pain can therefore be at significant risk of deficient nutritional intake, dehydration, and withdrawal from essential social interactions. Chronic pain is a multidimensional experience, with sensory-discriminative, emotional, cultural, and cognitive components. It is influenced by environment, hormonal, and mood fluctuations; neurologic and inflammatory changes; as well as cognitive and physiologic memory of previous encounters with pain. The successful treatment of pain requires thorough assessment of the cause and character of the pain, its underlying pathophysiology, and contribution of psychological, social, spiritual, and practical issues. Elucidating the qualities and characteristics of orofacial pain disorders and syndromes is essential for successful selection of therapies, according to various levels of evidence and based on rigorous research-based classification and diagnostic criteria. This chapter provides a concise and complete resource for dosing of the various classes and of pain medications and adjunctive medications in the treatment of orofacial pain across the age range from neonates to geriatric patients. Furthermore, this chapter addresses the unique physiology of each age group, the important alterations in pharmacokinetics which occur at various ages and with common comorbidities, and the importance of synergistic multimodal polypharmacy/analgesia. Successful management of orofacial pain must include not only pharmacologic interventions but also adequate follow-up with verbal and written education of the patient, family, and caregivers to assure compliance and decrease the incidence of adverse effects. Based on the complexity and chronicity of pain, its management may also require important interdisciplinary team members including nursing, social workers, pharmacists, chaplains, physiotherapists, occupational therapists, and stage of life specialists. Integration of cognitive behavioral therapies, physical medicine, and rehabilitation approaches, together with evidence-based alternative and mind–body approaches, improves patient satisfaction and well-being, decreases pain medication requirements, and lessens side effects compared to the use of medications alone.