Atypical facial pain
Encyclopedia
Atypical Facial Pain has historically been regarded as a pathological condition, including a wide group of facial pain problems. Generally, this pain is neuropathic in presentation, consisting of burning, superficial or deep-aching, stabbing pain
. AFP may also be described as poorly localized, typically involving the nose
, eye
, cheek
, temple
, and jaw
. Some practitioners have assigned this diagnostic label to any condition of facial pain in which pain simultaneously crosses the mid-line of the face, or otherwise fails to fit recognized patterns of other identified facial pain syndromes.
Predominant age: 30 to 60 years and predominant sex is female
.
Some sources have assigned or categorized Atypical Facial Pain as a psycho-somatic manifestation of so-called "Somatiform Symptom Disorder", as defined in the Diagnostic and Statistical Manual of the American Psychiatric Association. However, this categorization is increasingly being seen as inappropriate and actively damaging to patients. In a recent publication of the Trigeminal Neuralgia Association (TNA), Dr. Peter Jannetta and eleven other serving members of the TNA Medical Advisory Board concurred in the following finding:
"The term “atypical facial neuralgia or pain” was a wastebasket term applied by a serious
contributor of a former era to a group of patients he did not understand. Many of these patients
were our trigeminal neuralgia type 2 patients. It is unfortunate that many of these people were
told they had psychological problems. Many developed psychological problems after the fact when
told by everyone that such was their problem. Over the years, our areas of ignorance have
progressively narrowed.
"A non-pejorative and, hopefully, reasonable term for the ever-narrowing group of undiagnosed
face pain problems: Facepain of Obscure Etiology (FOE or POE) to replace atypical facial pain in
the Burchiel classification. Ref 1
, pain
, and throbbing. Physical examination
may be normal, but hypoesthesia
, hyperesthesia
, and allodynia
may be found.
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
. AFP may also be described as poorly localized, typically involving the nose
Nose
Anatomically, a nose is a protuberance in vertebrates that houses the nostrils, or nares, which admit and expel air for respiration in conjunction with the mouth. Behind the nose are the olfactory mucosa and the sinuses. Behind the nasal cavity, air next passes through the pharynx, shared with the...
, eye
Eye
Eyes are organs that detect light and convert it into electro-chemical impulses in neurons. The simplest photoreceptors in conscious vision connect light to movement...
, cheek
Cheek
Cheeks constitute the area of the face below the eyes and between the nose and the left or right ear. They may also be referred to as jowls. "Buccal" means relating to the cheek. In humans, the region is innervated by the buccal nerve...
, temple
Temple
A temple is a structure reserved for religious or spiritual activities, such as prayer and sacrifice, or analogous rites. A templum constituted a sacred precinct as defined by a priest, or augur. It has the same root as the word "template," a plan in preparation of the building that was marked out...
, and jaw
Jaw
The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of...
. Some practitioners have assigned this diagnostic label to any condition of facial pain in which pain simultaneously crosses the mid-line of the face, or otherwise fails to fit recognized patterns of other identified facial pain syndromes.
Predominant age: 30 to 60 years and predominant sex is female
Female
Female is the sex of an organism, or a part of an organism, which produces non-mobile ova .- Defining characteristics :The ova are defined as the larger gametes in a heterogamous reproduction system, while the smaller, usually motile gamete, the spermatozoon, is produced by the male...
.
Some sources have assigned or categorized Atypical Facial Pain as a psycho-somatic manifestation of so-called "Somatiform Symptom Disorder", as defined in the Diagnostic and Statistical Manual of the American Psychiatric Association. However, this categorization is increasingly being seen as inappropriate and actively damaging to patients. In a recent publication of the Trigeminal Neuralgia Association (TNA), Dr. Peter Jannetta and eleven other serving members of the TNA Medical Advisory Board concurred in the following finding:
"The term “atypical facial neuralgia or pain” was a wastebasket term applied by a serious
contributor of a former era to a group of patients he did not understand. Many of these patients
were our trigeminal neuralgia type 2 patients. It is unfortunate that many of these people were
told they had psychological problems. Many developed psychological problems after the fact when
told by everyone that such was their problem. Over the years, our areas of ignorance have
progressively narrowed.
"A non-pejorative and, hopefully, reasonable term for the ever-narrowing group of undiagnosed
face pain problems: Facepain of Obscure Etiology (FOE or POE) to replace atypical facial pain in
the Burchiel classification. Ref 1
Signs and Symptoms
Patient often reports symptoms of paresthesiaParesthesia
Paresthesia , spelled "paraesthesia" in British English, is a sensation of tingling, burning, pricking, or numbness of a person's skin with no apparent long-term physical effect. It is more generally known as the feeling of "pins and needles" or of a limb "falling asleep"...
, pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
, and throbbing. Physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
may be normal, but hypoesthesia
Hypoesthesia
Hypoesthesia refers to a reduced sense of touch or sensation, or a partial loss of sensitivity to sensory stimuli....
, hyperesthesia
Hyperesthesia
Hyperesthesia is a condition that involves an abnormal increase in sensitivity to stimuli of the sense. "When a non-noxious stimulus causes the sensation of pain the area will be termed hyperaesthetic". Stimuli of the senses can include sound that one hears, foods that one tastes, textures that...
, and allodynia
Allodynia
Allodynia is a pain due to a stimulus which does not normally provoke pain. Temperature or physical stimuli can provoke allodynia, and it often occurs after injury to a site...
may be found.
Tests
There are presently no accepted medical tests which consistently discriminate between facial pain syndromes or differentiate Atypical Facial Pain from other syndromes. However, a normal Radiograph, CT, and MRI may help to exclude other pathology such as arterio-veinous malformation, tumor, Temporomandibular Joint Disorder, or MS.Differential Diagnosis
- Trigeminal neuralgiaTrigeminal neuralgiaTrigeminal neuralgia , tic douloureux is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. It has been described as among the most painful conditions known...
- MigraineMigraineMigraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
- Dental diseasesDental diseaseDental diseases may affect the teeth, the gums, or other tissues and parts of the mouth. Dental diseases can cause much more serious problems than a toothache; they can affect our ability to chew, smile, or speak properly. Their severity may range from a simple aphthous ulcer, to a common tooth...
- NeoplasiaNeoplasiaNeoplasm is an abnormal mass of tissue as a result of neoplasia. Neoplasia is the abnormal proliferation of cells. The growth of neoplastic cells exceeds and is not coordinated with that of the normal tissues around it. The growth persists in the same excessive manner even after cessation of the...
- InfectionInfectionAn infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
Treatment
- Analgesics
- Antidepressants
- Centrally acting muscle relaxants
- Anticonvulsants