Response to Bouloux: Use of Opioids in Long-Term Management of Temporomandibular Joint Dysfunction

Abstract

Recently, Dr Gary Bouloux reviewed opioid management of chronic temporomandibular joint dysfunction-related pain. 1 Bouloux G.F. Use of opioids in long-term management of temporomandibular joint dysfunction. J Oral Maxillofac Surg. 2011; 69: 1885 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Appropriately, the review discussed the biopsychosocial model of chronic pain, issues of risk and benefit (consistent with the guidelines), 2 Chou R. Fanciullo G.J. Fine P.G. et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009; 10: 113 Abstract Full Text Full Text PDF PubMed Scopus (1691) Google Scholar , 3 Trescot A.M. Helm S. Hansen H. et al. Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians (ASIPP) Guidelines. Pain Physician. 2008; 11: S5 PubMed Google Scholar adjunct pain medications, and monitoring of use and misuse. Some available products were compared based on how well their characteristics match “the ideal opioid.” However, the regrettable reality is that no opioid remains “ideal” for a given patient indefinitely. Commonly, opioids must be periodically switched or rotated due to waning efficacy or the emergence of intolerable side effects. 4 Slatkin N.E. Opioid switching and rotation in primary care: implementation and clinical utility. Curr Med Res Opin. 2009; 25: 2133 Crossref PubMed Scopus (59) Google Scholar Response to Dr Howard SmithJournal of Oral and Maxillofacial SurgeryVol. 69Issue 11PreviewI would like to thank Dr Howard Smith for his insightful comments in regard to the use of opioids in the long-term management of temporomandibular joint dysfunction. The purpose of our review was to provide a rationale and understanding of the value of opioids in the management of chronic noncancer pain such as temporomandibular joint pain. The omission of tapentadol, transdermal buprenorphine, and oxymorphone resulted from a paucity of independent studies addressing these drugs in this patient group. Full-Text PDF