Face / Head / Neck

Atypical Facial Pain

Definition

Chronic atypical facial pain, also known as persistent idiopathic facial pain (PIFP), is a general name under which various pain syndromes of the face and mouth are classified.

According to the International Headache Society, persistent idiopathic facial pain (PIFP) is described as a persistent facial pain without the classical characteristics of cranial neuralgias and of which there is no known aetiology.

Aetiology

The pathophysiology of PIFP is unknown. Osteoporosis during the menopause can result in neuralgias, due to osteonecrosis of the facial cavities. Infections of the tooth cavities are potential risk factors. However, these are seldom the only cause of PIFP. Odontogenic nociceptive pain such as, pulpitis, pericoronitis and alveolitis must be excluded. As well as (or due to) nociceptive pain, neuralgias can co-exist.

Signs and symptoms

PIFP of or facial pain is defined as pain localised beneath the hair line, above the neck and in front of the ear.

PIFP has a chronic character with daily pain. Initially, the pain is frequently localised at one side. However, later on the pain can become bilateral in the face.  Patients have difficulties with localisation of the pain.

Diagnostics

Physical Examination

Patients with PIFP must be carefully examined in order to eliminate other aetiologies of facial pain. In some cases, a nasopharyngeal tumour can give rise to pain. This diagnosis is frequently made at the time a neurological deficit occurs. Hidden dental problems can be the cause of infection of the maxillary and/or jaw cavities after earlier tooth extractions.

Additional Somatic Diagnostics

The additional diagnostic or imaging techniques that will also have to be performed will depend upon the findings of a physical examination and the patient's signs and symptoms. In some cases, an MRI of the skull should also be considered.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclische antidepressiva
  • Anticonvulsiva: carbamazepine, oxcarbazepine, gabapentine en pregabaline.

Interventional Pain Treatment