What is the treatment for pain in submucosal fibrosis?

Treatment of Pain in Oral Submucous Fibrosis

The most effective treatment for pain in oral submucous fibrosis combines pharmacological management with intralesional injections of dexamethasone and hyaluronidase, which provides superior pain relief and improved mouth opening compared to other treatment modalities. 1

Pharmacological Management

• NSAIDs are recommended as first-line treatment for pain management in oral submucous fibrosis, similar to their use in other painful oral conditions 2
• Tramadol can be considered for moderate to severe pain that doesn't respond to NSAIDs, as it has demonstrated effectiveness in pain management with level Ib evidence 3
• Simple analgesics such as paracetamol can be used for mild pain, though they may provide only symptomatic relief 3
• Topical applications of triamcinolone acetonide 0.1% can provide localized pain relief in early stages of the disease 4

Intralesional Injections

• Combination of dexamethasone and hyaluronidase injections has shown superior results in reducing pain and improving mouth opening compared to other treatment modalities 1
• This combination therapy demonstrated the maximum reduction in pain by the 3rd month of treatment in comparative studies 1
• Intralesional injections are particularly beneficial for patients with moderate to severe pain and limited mouth opening (interincisal distance < 20 mm) 4

Adjunctive Therapies

• Lycopene (oral supplementation) can be considered as an alternative when steroids are contraindicated, though it's less effective than combination therapy with dexamethasone and hyaluronidase 1
• Curcumin lozenges have shown promising results in reducing pain associated with normal and spicy food consumption, with sustained improvement even during follow-up periods 5
• Vitamin B-complex and buflomedial hydrochloride oral administration combined with topical triamcinolone can provide symptomatic relief in mild cases 4

Treatment Algorithm Based on Disease Severity

For Mild Cases (Interincisal Distance > 20 mm):

1. Conservative oral administration of vitamin B-complex, buflomedial hydrochloride
2. Topical application of triamcinolone acetonide 0.1%
3. NSAIDs for pain management
4. Daily mouth opening exercises 4

For Moderate to Severe Cases (Interincisal Distance < 20 mm):

1. Intralesional injections of dexamethasone and hyaluronidase
2. Tramadol for pain management if NSAIDs are insufficient
3. Daily mouth opening exercises
4. Consider surgical intervention if medical management fails 4, 1

Important Considerations

• All treatment approaches should be combined with complete cessation of betel quid chewing habit, which is essential for long-term management 4, 6
• Daily mouth opening exercises are necessary regardless of the treatment modality chosen 4
• Conservative medical treatments typically provide only symptomatic relief in the long term, while surgical approaches may be necessary for significant improvement in severe cases 4
• Buccal fat pad grafting has shown particular success in reducing scarring compared to other surgical approaches in severe cases 4
• Treatment should be maintained for at least 3 months with regular follow-up to monitor progress and adjust therapy as needed 1, 5