Abstract
Patients: Case 1) A 70-year-old female had received the surgery in our department to remove a black lesion on the premolar buccal gingiva of the left mandible, X years back. Although the wound healed after the surgery completely, the patient has hypoesthesia of left mental nerve innervation. Moreover, because unpleasantness around the wound has also remained, she visited the Chronic Pain Clinic at the Department of Oral and Maxillofacial Surgery, Tokyo Medical University. Case 2) A 61-year-old female was treated for peri-implantitis and temporomandibular disorder in our department. Because the patient began to perceive the persistent tongue pain during the treatment period, she visited the Chronic Pain Clinic of our department. As a result of the medical interviews which performed for these patients many times, we diagnosed that psychosomatic treatments are needed in these case. Thus, these patients were referred to the Oral Pain Clinic of the Psychiatric department in our university. Although they were prescribed mirtazapine and milnacipran, neither medication was effective. Further, the patient of Case 2 reported some side effects. The medication was subsequently changed to duloxetine, thereby the reduction of symptoms in both patients were obtained.
Discussion: Although Tricyclic antidepressants (TCAs) have been used for chronic pain in the orofacial area, TCAs have various side effects, such as dry mouth, urinary retention, and abnormalities on electrocardiogram. Because the use of a safer drug is needed occasionally, we have worked on using antidepressants other than TCAs in our clinic proactively so far. As a consequence, we believe that it is important to follow the Guidelines for chronic pain of treatment, whereas considering side effects of drugs carefully, and providing the treatment that is specifically tailored to each patient.
Conclusions: We performed psychosomatic medical approach to the chronic pain of orofacial area, and reported the case which duloxetine was effective for the pain relief.
