Pharmacotherapeutic outcomes in atypical odontalgia: determinants of pain relief
Received 21 September 2018
Accepted for publication 4 January 2019
Published 27 February 2019 Volume 2019:12 Pages 831—839
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Katherine Hanlon
Trang TH Tu,1 Anna Miura,1 Yukiko Shinohara,1 Lou Mikuzuki,1 Kaoru Kawasaki,1 Shiori Sugawara,1 Takayuki Suga,1 Takeshi Watanabe,1 Yuma Aota,1 Yojiro Umezaki,2 Miho Takenoshita,1 Akira Toyofuku1
1Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; 2Department of Geriatric Dentistry, Fukuoka Dental College, Fukuoka, Japan
Objectives: There has been considerable research which has focused on clarifying the origin of pain in patients with atypical odontalgia (AO), also known as “idiopathic toothache”, and on identifying effective treatment, but there has been limited success so far. In this study, we assessed the outcomes of treatment and attempted to identify factors that could account for pain remission in patients with AO.
Patients and methods: Data for 165 patients diagnosed with AO from June 2015 to August 2017 were retrospectively reviewed. The patients’ sex, age, duration of pain, and psychiatric history were collected, along with information on pain intensity, depressive status, and catastrophizing scores. Responses at 4 and 16 weeks from the start of treatment were observed. The associations between potentially associated factors and outcome were investigated using Bayesian model averaging.
Results: A 30% reduction in pain was reported by 38 patients (46.3%) at 4 weeks and by 54 patients (65.9%) at 16 weeks. The pain intensity decreased as the depression and catastrophizing score improved; all of the changes were statistically significant (P<0.001). Four elements, that is, patient sex, depression score at baseline, pain score at 4 weeks, and change in the catastrophizing score, explained 52.5% of the variation in final outcome between individual patients.
Conclusion: Our findings confirm the efficacy of tricyclic antidepressants (TCAs) as a treatment for AO and indicate that other medications, especially aripiprazole used in combination with a TCA, may be useful. A considerable number of patients, especially women, those with lower levels of depression at baseline, and those who responded to 4 weeks of treatment, achieved pain relief.
Keywords: atypical odontalgia, orofacial chronic pain, depression, pain catastrophizing, tricyclic antidepressant, atypical antipsychotic
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