The Aetiology And Management Of ChronicIdiopathic Facial Pain: A Review (original) (raw)
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Multi-dimensionality of chronic pain of the oral cavity and face
Journal of Headache and Pain, 2013
Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management. The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
Clinical study of patients with persistent orofacial pain
Arquivos De Neuro-psiquiatria, 2004
OBJETIVE: To evaluate a sample of patients with persistent facial pain unresponsive to prior treatments. METHODS: Hospital records of 26 patients with persistent facial pain were reviewed (20 female and 6 male). RESULTS: Patients were classified into three groups according to their presenting symptoms: a)Group I, eight patients (30.7%) with severe, diffuse pain at the face, teeth or head; b)Group II, eight patients (30.7%) with chronic non-myofascial pain and; c)Group III, ten patients with chronic myofascial pain (38.4%). We find 11 different diagnoses among the 26 patients: pulpitis(7), leukemia(1), oropharyngeal tumor(1), atypical odontalgia(1), Eagle's syndrome(1), trigeminal neuralgia(4), continuous neuralgia(1), temporomandibular disorders (9), fibromyalgia (2), tension-type headache(1), conversion hysteria(2). After the treatment program all patients had a six-month follow-up period with pain relief, except the patient with tumor. CONCLUSION: The wide variability of orof...
Persistent idiopathic facial pain: multidisciplinary approach and assumption of comorbidity
Neurological Sciences, 2010
Persistent idiopathic facial pain (PIFP) is a complex and uncertain nosographic entity, which has many aspects that need to be explored. The 21 patients selected (male 4 and female 17, mean age 40 years) were under electromyography (EMG) to determine the efficiency of the masseter muscles (MM) and the anterior temporalis muscles (TA), during activity and at rest, and under kinesiography (CMS) to identify the physiological rest position of the mandible after TENS stimulation. These patients were rehabilitated with a neuromuscular orthosis to provisionally correct the discrepancies identified. The EMG mean values of the muscles at rest were significantly above the normal (two-sample t test) for all four muscles and were normalized after the TENS session (Wilcoxon rank test). CMS showed that all 21 patients needed a mandibular advancement and 90.5% a correction in the frontal plane, obtained with orthosis. The comparison between the values of the maximal clench on natural dentition and on the orthosis showed a decrease in the asymmetry of muscular strength (-30.21% for TA and -55.81% for MM; Wilcoxon rank test) and a net increase of the strength expressed (LTA ?25.37; LMM ?59.40%, RMM ?40.80%, RTA ?30.27; Wilcoxon rank test; sign test). Preliminary results show a net decrease also in VAS pain score with a mean shift from 9.5 to 3.1. The results suggest a role for the neuromuscular component of the craniomandibular system in the pathogenesis of chronic idiopathic facial pain. All patients with PIFP should undergo the CMS-EMg examination.
PSYCHOLOGICAL FACTORS ASSOCIATED WITH CHRONIC OROFACIAL PAIN
Pain is one of the most common symptoms encountered in clinical practice and the head is a frequent site of pain. Chronic Orofacial Pain (COP) represents a complex pain condition with an etiology comprised of many factors including those falling within biological, psychological, and social domains. Psychogenic regional pain is a term used for "pain that patients feel in a region of the body where no peripheral cause can be found and is psychogenic in its evocation". Even in the field of psychology/psychiatry, many aetiologies and psychodynamics have been related to the development of psychogenic pain. This article deals with the treatment modalities to deal with the psychological repercussions of physical, orofacial pain. .
International Journal of Clinical Pediatric Dentistry
Aim: The following case report discusses the diagnostic dilemma presented by and the multidisciplinary management of a patient with chronic atypical facial pain of psychogenic origin. Background: Though oral health care professionals are primarily concerned with the treatment of somatic disorders of the orofacial region, there remains a particularly challenging need to identify, diagnose and treat various psychological and psychosomatic symptoms. Case description: This case report describes the management of a 13-year-old male patient with the chief complaint of pain and discoloration of the skin over the right side of the face for the last 5 months, who also demonstrated symptoms of chronic anxiety and social withdrawal. As no associated soft or hard tissue abnormalities could be identified, a diagnosis of atypical/psychogenic facial pain was established. The skin discoloration was diagnosed as pityriasis versicolor and treatment for the same commenced. Following the complete resolution of the skin lesion the patient was asymptomatic, and no longer anxious. Conclusion: Our role as dentists is to mitigate the suffering of patients and to improve their quality of life in collaboration with specialists in psychosomatic medicine. Clinical significance: This case highlights that dentists must be trained to treat not only teeth, but also attend to patient's psychosomatic symptoms.
Biopsychosocial assessment and management of persistent orofacial pain
Oral Surgery, 2020
Persistent orofacial pain (OFP) presents as a range of conditions of complex aetiology which include interacting biological, psychological and social aspects. Biopsychosocial factors have an impact on the development, maintenance and severity of pain disorders as well as on their treatment. Since OFP is unlikely to be cured, given current knowledge, patients need to play an active role in using strategies to reduce their pain or the impact it has on their life. This is known as self‐management and provides a firm foundation for tailored medical management strategies. Biopsychosocial considerations have an important role in supporting successful self‐management. This review describes biopsychosocial factors that may be important to consider in routine care settings. Psychological factors that are known to affect outcome include anxiety and depression and, more specifically catastrophising and self‐efficacy. Research into pain management in other conditions also stresses the importanc...
Cadernos UniFOA
Objectives: Review the literature on psychogenic face or head pain, develop a diagnostic questionnaire for psychogenic head and face pain and present three clinical cases presenting psychogenic pain. Material and Methods: Review of 18 papers on psychogenic pain to develop a diagnostic questionnaire with questions to be answered by patients that presented these three clinical cases. Results: The common things observed in three patients presenting psychogenic pain were higher scores in bruxing behavior, depression, somatization, severe pain and the presence of psychic conflict. Conclusions: Various types of other face and headaches occur in subjects with psychogenic face and head pain. Psychogenic pain individuals usually present severe pain associated with depression. Psychic conflict, somatization and depression are usually associated with psychogenic pain.
Pain, 2010
Due to the cross-sectional nature of previous studies, whether mechanical factors predict the onset of Chronic oro-facial pain remains unclear. Aims of the current study were to test the hypotheses that self-reported mechanical factors would predict onset of Chronic oro-facial pain and that any observed relationship would be independent of the confounding effects of psychosocial factors and reporting of other unexplained symptoms. About 1735 subjects who had completed a baseline questionnaire were assessed at 2 year follow-up for the presence of Chronic oro-facial pain, psychosocial factors (anxiety and depression, illness behaviour, life stressors and reporting of somatic symptoms), mechanical dysfunction (facial trauma, grinding, phantom bite and missing teeth) and reporting of other unexplained symptoms (chronic widespread pain, irritable bowel syndrome and chronic fatigue). About 1329 subjects returned completed questionnaires (adjusted response rate 87%). About 56 (5%) reported new episodes of Chronic oro-facial pain at follow-up. Univariate analyses showed that age, gender, reporting of other unexplained symptoms, psychosocial factors and two self-report mechanical factors predicted the onset of Chronic oro-facial pain. However multivariate analysis showed that mechanical factors did not independently predict onset. The strongest predictors were health anxiety (Relative Risk (RR) 2.8, 95% CI 1.3–6.2), chronic widespread pain (RR 4.0 95% C.I. 2.2–7.4) and age (RR 0.2, 95% CI 0.1–0.7). The findings from this prospective study support the hypothesis that psychosocial factors are markers for onset of Chronic oro-facial pain. The efficacy of early psychological management of Chronic oro-facial pain to address these factors should be a priority for future investigations.
Chronic orofacial pain: is the puzzle unraveling?
Journal of dental education, 2001
Conditions involving chronic orofacial pain represent a major health problem, and patients with persistent pain are difficult to manage successfully. These conditions are often comorbid with additional health issues such as sleep disturbances, cardiovascular, gastrointestinal and reproductive system complaints, weight loss or weight gain, swelling, numbness, sweating and flushing, and concerns regarding loss of libido, drive, attention, and memory. Neuroendocrine and autonomic pain-stress responsivity and the consequences of pain for sensory, motor, immune and reproductive functions, and mood seem to account for the broad range of comorbid complaints. Susceptibility to a particular response appears to explain intra-individual differences in disease expression. Understanding of these regulatory, mostly adaptive processes will support novel treatments to manage many troublesome comorbid complaints for which current approaches are unsatisfactory.