Herbal extracts in orofacial pain: a systematic review and direct and indirect meta-analysis

Abstract

The pharmaceutical industry has been primarily focused on developing synthetic drugs to address orofacial pain (OFP)-related conditions. There is limited knowledge regarding the efficacy of the use of herbal extracts in treating OFP. A systematic review and a meta-analysis of 62 randomized controlled trials assessing the analgesic effects of herbal extracts on pain intensity in various orofacial conditions was conducted. The intervention comprised the use of herbal extracts compared with a placebo and/or standard treatment. The primary outcome was pain intensity assessed before and after the intervention. The pain scores were compared with the baseline scores in each treatment. When compared with standard therapy, the pooled results of the patients who received herbal extracts revealed lower pain intensity in periodontal pain (MD = -0.92[-6.69, 4.85]), oral surgery pain (MD = 18.80[8.80, 28.79]), oral neuropathic pain (MD = 20.34[6.16, 34.52]), endodontic pain (MD = -8.04[-11.72, -4.37]), oral mucosal pain (MD = 8.74[2.76, 14.73]), and temporomandibular pain (MD = 30.94[6.04, 55.83]). The findings indicated a pain-attenuating effect of herbal extracts such as cannabis, turmeric, capsaicin, licorice, ginger, chamomile, clove, Hypericum perforatum, and Arnica montana. These findings revindicate that herbal extracts may be valuable alternatives to traditional pain medications and promising source for the development of new active ingredients for pharmaceuticals.

Keywords: Herbal; Non-pharmacological; Oral; Orofacial; Pain.

Fig. 1

PRISMA flow diagram of the study selection.

Fig. 2

Risk of bias assessment of included studies.

Fig. 3

Herbal extracts for periodontal pain, oral surgery pain and oral neuropathic pain forest plots.

Fig. 4

Herbal extracts for endodontic pain, oral mucosal pain and TMD pain forest plots.

Fig. 5

Herbal extracts for orofacial pain network plots categorized by type of orofacial pain and plant family.

Fig. 6

Surface under the cumulative ranking score (SUCRA) of herbal extracts for periodontal pain, oral surgery pain, oral neuropathic pain, endodontic pain, oral mucosal pain and TMD pain.