Prospective three-year follow up of a cohort study of 240 patients with chronic facial pain (original) (raw)
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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
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.
The Journal of Headache and Pain, 2021
Headache and facial pain are among the most common, disabling and costly diseases in Europe, which demands for high quality health care on all levels within the health system. The role of the Danish Headache Society is to educate and advocate for the needs of patients with headache and facial pain. Therefore, the Danish Headache Society has launched a third version of the guideline for the diagnosis, organization and treatment of the most common types of headaches and facial pain in Denmark. The second edition was published in Danish in 2010 and has been a great success, but as new knowledge and treatments have emerged it was timely to revise the guideline. The recommendations for the primary headaches and facial pain are largely in accordance with the European guidelines produced by the European Academy of Neurology. The guideline should be used a practical tool for use in daily clinical practice for primary care physicians, neurologists with a common interest in headache, as well ...
Acta Otorhinolaryngologica Italica, 2018
SUMMARY Facial pain remains a diagnostic and therapeutic challenge for both clinicians and patients. In clinical practice, patients suffering from facial pain generally undergo multiple repeated consultations with different specialists and receive various treatments, including surgery. Many patients, as well as their primary care physicians, mistakenly attribute their pain as being due to rhinosinusitis when this is not the case. It is important to exclude non-sinus-related causes of facial pain before considering sinus surgery to avoid inappropriate treatment. Unfortunately, a significant proportion of patients have persistent facial pain after endoscopic sinus surgery (ESS) due to erroneous considerations on aetiology of facial pain by physicians. It should be taken into account that neurological and sinus diseases may share overlapping symptoms, but they frequently co-exist as comorbidities. The aim of this review was to clarify the diagnostic criteria of facial pain in order to ...
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...
2013
Ó The Author(s) 2012. This article is published with open access at Springerlink.com Abstract Headache and facial pain are among the most common, disabling and costly disorders in Europe. Correct diagnosis and treatment is important for achieving a high quality of care. As a national organisation whose role is to educate and advocate for the needs of patients with primary headaches, the Danish Headache Society has set up a task force to develop a set of guidelines for the diagnosis, organisation and treatment of the most common types of headaches and for trigeminal neuralgia in Denmark. The guideline was published in Danish in 2010 and has been a great success. The Danish Headache Society decided to translate and publish our guideline in English to stimulate the discussion on optimal organisation and treatment of headache disorders and to encourage other national headache
Persistent facial pain conditions
Den norske tannlegeforenings Tidende
Persistent facial pains, especially temporomandibular disorders (TMD), are common conditions. As dentists are responsible for the treatment of most of these disorders, up-to date knowledge on the latest advances in the field is essential for successful diagnosis and management. The review covers TMD, and different neuropathic or putative neuropathic facial pains such as persistent idiopathic facial pain and atypical odontalgia, trigeminal neuralgia and painful posttraumatic trigeminal neuropathy. The article presents an overview of TMD pain as a biopsychosocial condition, its prevalence, clinical features, consequences, central and peripheral mechanisms, diagnostic criteria (DC/TMD), and principles of management. For each of the neuropathic facial pain entities, the definitions, prevalence, clinical features, and diagnostics are described. The current understanding of the pathophysiology of these entities is presented, and a description of the evidence based treatment methods is provided.
Rhinology, 2015
Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined to the midface cor- responding to the second division of the trigeminal nerve. This review presents treatment outcomes of MSP patients managed at the Multi-disciplinary Team (MDT) Facial Pain Clinic in Liverpool. Prospective clinical outcome performed in a tertiary referral centre for complex facial pain syndromes. Sino-Nasal Outcome Test (SNOT). Clinical "success" was defined as an improvement in total SNOT score of >9 points and a reduction of the ear-facial symptoms sub-domain score by ≥50% from baseline. The average age of the cohort was 49 years, with an average follow-up of 12 months. The overall pre-treatment total SNOT-22 score was 59.5 which improved significantly to 42 at latest follow-up. Although the average scores of all sub-domains improved, only the ear-facial symptoms and psychological issues sub-domains achieved statistical significance. When the criterion fo...
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.