Reflections on the nosology of cranio-facial pain syndromes (original) (raw)
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International Journal of Environmental Research and Public Health
Background: Orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes mainly characterized by painful attacks localized in facial and oral structures. According to the International Classification of Orofacial Pain (ICOP), the last three groups (non-dental facial pain, NDFP) are cranial neuralgias, facial pain syndromes resembling primary headache syndromes, and idiopathic orofacial pain. These are often clinical challenges because the symptoms may be similar or common among different disorders. The diagnostic efforts often induce a complex diagnostic algorithm and lead to several imaging studies or specialized tests, which are not always necessary. The aim of this study was to describe the encountered difficulties by these patients during the diagnostic–therapeutic course. Methods: This study was based on the responses to a survey questionnaire, administered to an Italian Facebook Orofacial Patient Group, searching for pain characteristics and diagnostic–therapeutic ca...
Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach
European Neurology, 2020
Background: Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. Objective: The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. Methods: An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers sh...
Facial pain: clinical differential diagnosis
The Lancet Neurology, 2006
Differential diagnosis of pain in the face as the presenting complaint can be difficult. We propose an approach based on history and neurological examination, which allows a working diagnosis to be made at the bedside, including aetiological hypotheses, leading to a choice of investigations. Neuralgias are characterised by stabs of short lasting, lancinating pain, and, although neuralgias are often primary, imaging may be needed to exclude symptomatic forms. Facial pain with cranial nerve symptoms and signs is almost exclusively of secondary origin and requires urgent examination. Facial pain with focal autonomic signs is mostly primary and belongs to the group of the idiopathic trigeminal autonomic cephalalgias, but can occasionally be secondary. Pure facial pain is most often due to sinusitis and the chewing apparatus, but also a multitude of other causes. The pain can also be idiopathic. Imaging as well as non-neurological specialist assessment is often necessary in these cases. Panel 1: Helpful clinical features in patients with facial pain Localisation Time pattern Onset (sudden, gradual) Circadian distribution (day, night, random) Course and progression (constant, paroxysmal-recurrent, slowly/rapidly progressive) Duration Quality Intensity Precipitating and alleviating factors Associated symptoms and signs Panel 2: Proposed clinical classification of facial pain syndromes Neuralgias Facial pain syndromes with cranial nerve symptoms and signs Trigeminal autonomic cephalalgias (episodic facial pain syndromes with focal autonomic signs) Pure facial pain 264 http://neurology.thelancet.com Vol 5 March 2006
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.
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.
Idiopathic Non-Dental Facial Pain Syndromes in Italian Children: A Clinical Case Series
Life
Background. The orofacial pain syndromes (OFPs) are a heterogeneous group of syndromes characterized by painful attacks involving the orofacial structures. They may be summarily subdivided into two great categories: (1) orofacial pain mainly attributed to dental disorders such as dentoalveolar and myofascial orofacial pain or temporomandibular joint (TM) pain; (2) orofacial pain mainly attributed to non-dental pain as neuralgias, facial localization of primary headaches or idiopathic orofacial pain. The second group is uncommon, often described by single case reports, can often show overlapping symptoms with the first group, and represents a clinical challenge, carrying the risk of undervaluation and possibly invasive odontoiatric treatment. We aimed to describe a clinical pediatric series of non-dental orofacial pain and better to underline some topographic and clinical features associated with them. We retrospectively collected the data of children admitted to our headache centers...
Facial pain: neurological and non-neurological
Journal of Neurology, Neurosurgery, and Psychiatry, 2002
he article will give the reader: c An overview of facial pain in terms of epidemiology, classification, diagnosis and management c Three case histories on which to try out diagnostic skills c An overview of management of three types of facial pain.
Chronic Pain and Overview or Differential Diagnoses of Nonodontogenic Orofacial Pain
Primary Dental Journal, 2018
Orofacial pain is defined as pain arising from the regions of the face and mouth. Dental pain is the most common inflammatory pain presenting in this region; however, chronic pain conditions presenting frequently, including temporomandibular joint disorders (TMDs), primary headaches (neurovascular), neuropathic pain and idiopathic pain conditions, can often mimic toothache. Dentists are familiar with TMDs but have no training or experience in diagnosing or treating headaches that mainly present in the first trigeminal division. The anatomical complexity of the region and the potential possible diagnoses, mean that correct diagnosis is often delayed resulting in patients often undergoing inappropriate surgical and medical treatments that themselves may complicate the presentation of the pain by changing its phenotype and further complicating diagnosis and appropriate management. Due to the variable pain presentation of toothache, it can mimic many different chronic episodic orofacial...
Differential diagnosis of facial pain and guidelines for management
British Journal of Anaesthesia, 2013
† Accurate diagnosis of facial pain is the first step in successful management. † Dental and non-dental causes are both common, with consequent difficulties in appropriate referral. † The evidence for management is often extrapolated from other chronic pain conditions. † Well-designed clinical trials of facial pain are needed, with clinically relevant outcome measures. Summary. The diagnosis and management of facial pain below the eye can be very different dependant on whether the patient visits a dentist or medical practitioner. A structure for accurate diagnosis is proposed beginning with a very careful history. The commonest acute causes of pain are dental and these are well managed by dentists. Chronic facial pain can be unilateral or bilateral and continuous or episodic. The commonest non-dental pains are temporomandibular disorders (TMDs), especially musculoskeletal involving the muscles of mastication either unilaterally or bilaterally; they may be associated with other chronic pains. A very wide range of treatments are used but early diagnosis, reassurance and some simple physiotherapy is often effective in those with good coping strategies. Dentists will often make splints to wear at night. Neuropathic pain is usually unilateral and of the episodic type; the most easily recognized is trigeminal neuralgia. This severe electric shock like pain, provoked by light touch, responds best to carbamazepine, and neurosurgery in poorly controlled patients. Trauma, either major or because of dental procedures, results in neuropathic pain and these are then managed as for any other neuropathic pain. Red flags include giant cell arteritis which much be distinguished from temporomandibular disorders (TMD), especially in .50 yr olds, and cancer which can present as a progressive neuropathic pain. Burning mouth syndrome is rarely recognized as a neuropathic pain as it occurs principally in peri-menopausal women and is thought to be psychological. Chronic facial pain patients are best managed by a multidisciplinary team.