Treatments of Orofacial Muscle Pain: A Review of Current Literature

Research Article

J Dent & Oral Disord. 2017; 3(5): 1075.

Treatments of Orofacial Muscle Pain: A Review of Current Literature

Mulder MJHL¹* and Spierings ELH²

¹Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands

²Division of Craniofacial Pain, Department of Diagnostic Sciences, Tufts University School of Dental Medicine; Headache & Face Pain Program, Department of Neurology, Tufts Medical Center and Tufts University School of Medicine, USA

*Corresponding author: Maxim J.H.L. Mulder, Department of Neurology, Erasmus University Medical Center, Rotterdam, Netherlands

Received: September 12, 2017; Accepted: October 16, 2017; Published: October 23, 2017


Background: There are a large number of treatment options for Orofacial Muscle Pain (OMP). It remains uncertain which treatments are the most effective when it comes to reducing spontaneous pain resulting from OMP.

Objective: The purpose of the present paper is to review the controlled medical/dental studies related to the treatment of OMP.

Methods: For an inventory of the treatments, we researched the literature without time limit and with PubMed® as the search engine, using the term OMP as well as the numerous synonyms encountered while reviewing the papers generated. We focused on effects of treatment on spontaneous pain. We divided the treatment studies into negative-controlled and non-controlled studies and analyzed them separately.

Results: The literature search generated 58 studies on 18 different treatment options, each including 9 to 90 patients. Of 13 treatments the effect on spontaneous pain was studied compared to a negative-controlled group. The treatments that showed benefit in randomized, blinded, negative-controlled studies were: myofascial therapy, laser, botulinum toxin, ping on ointment, melatonin, and gabapentin.

Conclusions: A number of studies lacked a negative control and were underpowered as to the number of subjects included. The reviewed studies suggest efficacy for6 different treatments: myofascial therapy, laser, botulinum toxin, ping on ointment, melatonin, and gabapentin.

Keywords: Face pain; Orofacial muscle pain; Temporomandibular disorder; Masseter myalgia; Spontaneous pain


Chronic orofacial pain is relatively common and affects an estimated 7% of the general Western population [1]. It is commonly caused by Orofacial Muscle Pain (OMP), with pain located peripherally in the face or in the jaw(s), non-neuropathic in nature, and generally continuously present [2]. The pain of OMP originates from the muscles of mastication, particularly the masseter muscles. The cause is a dysfunction of those muscles, resulting in myalgia [3]. In the most recent classification for temporomandibular disorders, myalgia is a subcategory within muscle pain of the masticatory muscles and it assembles: local myalgia, myofascial pain and myofascial pain with referral. It should be distinguished from tendonitis, spasm and myositis [4].

In the literature, OMP is described under a great variety of terms as listed (Table 1). There is a wide range of treatment options available for OMP with the primary purpose of reducing spontaneous pain in these patients. Despite the fact that orofacial pain caused by OMP is a commonly encountered problem, it remains uncertain which treatments are most effective. This results in large practice variety, suboptimal treatment, and prolonged disability. Therefore, we aimed to review the current literature on the treatments of OMP.


Using the terms listed in Table 1, we conducted extensive research of the literature on the medical/dental treatments of OMP. We used PubMed® as the search engine and applied no time limit. We performed the search in November 2016. Only studies in English that reported spontaneous pain scores in humans as an outcome measure were included and studies that reported surrogate endpoints only, such as pressure pain threshold or un-assisted mouth opening, were not included. The treatment should have been performed in patients with OMP only and not in mixed patient populations (i.e., patients with other temporomandibular disorders). Case reports, i.e., series of less than five patients, were excluded. The studies were analyzed in two sections: negative-controlled studies (placebo-, sham-, and waiting list-controlled) and non-controlled studies. Comparative studies without a negative control were analyzed under the section of non-controlled studies, separately for the treatments compared.