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An update of management of insomnia in patients with chronic orofacial pain.

Oral diseases
November 1, 2017
G Almoznino et al. (4 authors)
Journal ArticleReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the role of melatonin receptor agonists, like ramelteon, in the management of insomnia among chronic orofacial pain patients.

Results Summary

The study suggests that melatonin receptor agonists, including ramelteon, are among the FDA-approved pharmacological options for treating insomnia, which can subsequently improve chronic orofacial pain. Non-pharmacological therapies are recommended first, but pharmacological options like ramelteon are considered effective when needed.

Population

Chronic orofacial pain patients with insomnia.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (8)
InterventionDirectionEndpointPopulationDosageImpactClaim #
non-pharmacological therapy
neutral
insomnia treatment
patients with insomnia
-
should begin with
#1
behavioral therapies for insomnia
neutral
sleep hygiene, cognitive behavioral therapy for insomnia, multicomponent behavioral therapy or brief behavioral therapy for insomnia, relaxation strategies, stimulus control, and sleep restriction
patients with insomnia
-
include
#2
benzodiazepines (estazolam, flurazepam, temazepam, triazolam, and quazepam)
neutral
insomnia
-
-
approved to treat
#3
non-benzodiazepine hypnotics (eszopiclone, zaleplon, zolpidem)
neutral
insomnia
-
-
approved to treat
#4
melatonin receptor agonist ramelteon
neutral
insomnia
-
-
approved to treat
#5
antidepressant doxepin
neutral
insomnia
-
-
approved to treat
#6
orexin receptor antagonist suvorexant
neutral
insomnia
-
-
approved to treat
#7
treatment of the underlying insomnia
increase
chronic orofacial pain
chronic orofacial pain patients
-
can greatly improve
#8
Abstract

In this review, we discuss the management of chronic orofacial pain (COFP) patients with insomnia. Diagnostic work-up and follow-up routines of COFP patients should include assessment of sleep problems. Management is based on a multidisciplinary approach, addressing the factors that modulate the pain experience as well as insomnia and including both non-pharmacological and pharmacological modalities. Parallel to treatment, patients should receive therapy for comorbid medical and psychiatric disorders, and possible substance abuse that may be that may trigger or worsen the COFP and/or their insomnia. Insomnia treatment should begin with non-pharmacological therapy, to minimize potential side effects, drug interactions, and risk of substance abuse associated with pharmacological therapy. Behavioral therapies for insomnia include the following: sleep hygiene, cognitive behavioral therapy for insomnia, multicomponent behavioral therapy or brief behavioral therapy for insomnia, relaxation strategies, stimulus control, and sleep restriction. Approved U.S. Food and Drug Administration medications to treat insomnia include the following: benzodiazepines (estazolam, flurazepam, temazepam, triazolam, and quazepam), non-benzodiazepine hypnotics (eszopiclone, zaleplon, zolpidem), the melatonin receptor agonist ramelteon, the antidepressant doxepin, and the orexin receptor antagonist suvorexant. Chronic orofacial pain can greatly improve following treatment of the underlying insomnia, and therefore, re-evaluation of COFP is advised after 1 month of treatment.

Medical Subject Headings (MeSH)
AminesAnticonvulsantsAntidepressive AgentsBenzodiazepinesChronic PainCognitive Behavioral TherapyCyclohexanecarboxylic AcidsFacial PainGabapentinHumansHypnotics and SedativesMelatoninOrexin Receptor AntagonistsPregabalinSleep Initiation and Maintenance Disordersgamma-Aminobutyric Acid
Study Links
Quality Scores
SafetyNot Assessed
Efficacy75/10
Quality80/10
Citation Metrics
Total Citations11
Citations/Year1.4
Relative Citation Ratio0.62
NIH Percentile33.7%
Research Impact Scores
APT Score0.25
Weight Score1.90
Normalized Score0.66
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