Practical pharmacological approach of orofacial pains: realities and clinical recommendations

An analgesic (or pain killer) is a drug used to achieve analgesia (relief from pain): this drug can work either on peripheral or central nervous system. Analgesics are different from anesthetics which reversibly eliminate pain sensation. When managing orofacial pains, analgesic choice is determined by the type of pain and its severity. The WHO “Pain Ladder” (or analgesic ladder) is a 3-step “ladder” for cancer pain in adults. It described the guidelines for the use of drugs in pain management: the general principle is to start with first step drugs(non-opioid), and then, to climb the ladder if pain is still present, and medications usually range from household (over-the-counter) drugs (acetaminophen and NSAIDs), to powerful opioids (morphine, buprenorphine, oxycodone). For neuropathic orofacial pains, tricyclic antidepressants, class I antiarrythmics, and anticonvulsants remain the drugs of choice.