Little good evidence currently available to support the effectiveness of antidepressants in the treatment of orofacial pain


Orofacial pain is a relatively common and is categorized into musculoskeletal; neuropathic; vascular; neurovascular; idiopathic; pain caused by local, distant, or systemic pathology; and psychogenic.  Diagnosis can be challenging when psychosocial factors are present and while antidepressants have been used as a treatment there remains some controversy.  The aim of this review was to assess the effectiveness of antidepressants in the treatment of orofacial pain.

The PubMed database was searched for randomised controlled trials dealing with a wide range of orofacial pain disorders.  Study selection was conducted independently, by two authors, with quality being assessed using a 15 item checklist.  Only trials in English or Dutch with pain intensity as the main outcome measure were considered.

  • Six articles were included, 4 randomized placebo-controlled trials and 2 randomized active-controlled trials.  The studies considered burning mouth syndrome, bruxism, temporomandibular joint disorders, radiation induced pain, atypical facial pain and post herpetic neuralgia.
  • The 6 included studies were considered to be of high quality

The authors concluded

there was limited evidence to support the effectiveness of antidepressants in orofacial pain disorders, because of the heterogeneity of treatment modalities and the low number of randomized controlled trials per diagnoses. More randomized controlled trials are needed to come to a firm conclusion for the use of antidepressants for orofacial pain disorders.


As only a single database was used this is not technically a systematic review.  The use of additional databases may have identified more studies.  A 2005 Cochrane review by Zakrewska looking at interventions to treat burning mouth syndrome included two trails of antidepressants, only one of which is included in this review. Neither of these trials found a significant difference between the groups.


Martin WJ, Perez RS, Tuinzing DB, Forouzanfar T. Efficacy of antidepressants on orofacial pain: a systematic review. Int J Oral Maxillofac Surg. 2012 Oct 4.pii: S0901-5027(12)00376-1. doi:10.1016/j.ijom.2012.09.001. [Epub ahead of print] PubMed PMID:23041255.

Zakrzewska JM, Forssell H, Glenny AM. Interventions for the treatment of burning mouth syndrome. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD002779. DOI: 10.1002/14651858.CD002779.pub2.




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