Antidepressants used as treatment for chronic jaw pain

Reid Friesen, assistant professor at the University of Alberta Mike Petryk School of Dentistry in the faculty of medicine and dentistry was the senior author of the review investigating the effects of antidepressants on chronic jaw pain, more specifically, temporomandibular disorders (TMDs). 

In both clinical and teaching settings, Friesen deals with “a lot of orofacial pain and TMD conditions,” and these patients are “often very difficult to treat.”

Frequently encountering these conditions led him to look into novel treatments and research, which led him to consider medications, he explained.

“There’s a lot of overlap between depression, anxiety, and chronic pain,” according to Friesen.

He shared that it was a combination of clinical need and personal interest that led him down this avenue of research.

The researchers found that combining antidepressants with other therapies, in a multimodal approach, often works best. According to Friesen, the “most foundational treatment is patient education awareness.”

He explained the importance of patients understanding “what they have, why they have it, and [how they can] make decisions that aren’t going to aggravate their pain.”

Additionally, understanding the risks that come with their condition is also vital, Friesen said.

Beyond this understanding, providers will generally “give [patients] exercises, stretches, [recommend] applying heat and cold,” and they will often “co-ordinate with physiotherapists who have different types of treatments, that can help with chronic muscle and joint pain.”

Friesen explores new treatment approaches to chronic pain

Friesen’s own area of expertise, “from a dental perspective,” includes the use of “dental appliances, particularly for patients that clench and grind their teeth.”

When considering pain medications, Friesen highlighted that “people with chronic pain don’t really respond to acute pain medications like Advil and Tylenol,” which is what led to the antidepressants study. In rare cases, Friesen explained, surgery may be recommended to alleviate TMD chronic pain.

Patients that have a “high psychosocial burden, with anxiety, depression, or other psychiatric diagnoses like Post Traumatic Stress Disorder (PTSD), often need to see a psychologist to work through those things that are implicated in chronic pain.”

Patients with a high psychosocial burden, “meaning they have a lot of comorbid psychological issues, which is very common in the context of chronic pain, tend to respond best” to the antidepressant-based treatments. Additionally, better responses are observed in patients experiencing chronic muscle pain, according to Friesen.

However, Friesen said physiotherapy, or surgery in severe cases, often work better for patients with structural issues of the joint, such as arthritis.

“It would be interesting to further segment exactly which patients are going to benefit from this,” Friesen said. Developing tools to “prioritize who’s going to respond to what treatments” is a potential avenue for his future research.

Beyond antidepressants, Friesen has an interest in understanding “who responds to what and why” in terms of all medications and treatments, therefore providing “more targeted and patient specific treatments.”

The U of A Oral Health Clinic is “working with a group out of Montreal on a project looking at risk factors for developing chronic pain,” according to Friesen. He said he could “see that information providing input as to who would benefit from different treatments.”