This project is attempting to evaluate pharmacological approaches to the clinical management of chronic facial pain and to develop better method for its differential diagnosis. Two clinical trials have evaluated standard pharmacological agents for the management of two different variants of chronic facial pain: myofascial pain dysfunction (MPD) and atypical facial pain (AFP). These studies seek to evaluate the efficacy of prototypic pharmacologic regimens under conditions of a controlled clinical trial. Thirty-nine subjects completed the MPD study. Pain relief, as measured by the pain relief VAS, revealed significantly greater relief from diazepam than ibuprofen or placebo. No significant changes were seen in depression or anxiety in comparison to baseline or between groups. These data indicate that diazepam results in symptomatic relief of MPD when evaluated under conditions of a controlled trial, suggesting that anxiolytic drug therapy is effective for the relief of myofascial pain while NSAIDS have minimal therapeutic benefit when used alone. Amitriptyline was more effective than placebo in reducing atypical facial pain after four weeks of treatment. When patients were divided into depressed and non-depressed groups, based on their Hamilton depression scores, amitriptyline reduced pain in the depressed and in the non-depressed groups as compared to placebo. Amitriptyline reduced the depression scores in the depressed group but had no effect on the depression scores in the non-depressed group. These data suggest that amitriptyline is effective in the treatment of chronic oral-facial pain and that its efficacy is independent of its effects on depression.
