<p>Challenges of Misdiagnosis and Suboptimal Treatment of Persistent Idiopathic Facial Pain and Atypical Odontalgia: A Retrospective Multi-Centric Cross-Sectional Investigation</p>

Abstract Background Persistent idiopathic facial pain (PIFP) is the unexplained pain along the territory of the trigeminal nerve, including nonorganic tooth pain called atypical odontalgia (AO). Though PIFP is debilitating to patients’ livelihood and well-being, its pathophysiology remains poorly understood. Although neurovascular compression (NVC) of the trigeminal nerve is known to be associated with trigeminal neuralgia (TN), the relationship between NVC and other orofacial pains has not been fully elucidated. Methods In this study, we investigated the differences in the characteristics of PIFP (primarily AO) patients in the presence or absence of NVC. A retrospective analysis was performed on data from 121 consecutive patients who had been diagnosed with unilateral PIFP according to the criteria of the International Classification of Headache Disorders (ICHD)–3 and underwent magnetic resonance imaging scans of the head. Results In the group without NVC, characteristic findings were significant for psychiatric morbidity, somatization, and pain disability, when compared with the group with NVC. Furthermore, the group without NVC exhibited significant headache, noncardiac chest pain, shortness of breath, and pain catastrophizing. Conclusions These results suggest that PIFP patients can be divided into two groups: one consistent with a neuropathic pain phenotype when NVC is present and a functional somatic symptom phenotype when presenting without NVC. Our findings may enable a more precise understanding of pathophysiology of PIFP and lead to better treatment strategies.

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Evaluation of patients suffered from burning mouth syndrome and persistent idiopathic facial pain using Japanese version PainDETECT questionnaire and depression scales

Journal of Dental Sciences ◽

10.1016/j.jds.2020.06.008 ◽

2021 ◽

Vol 16 (1) ◽

pp. 131-136

Author(s):

Aiji Sato (Boku) ◽

Hiroyuki Kimura ◽

Tatsuya Tokura ◽

Eri Umemura ◽

Tomoya Miyauchi ◽

...

Keyword(s):

Facial Pain ◽

Japanese Version ◽

Burning Mouth Syndrome ◽

Persistent Idiopathic Facial Pain ◽

Paindetect Questionnaire ◽

Burning Mouth ◽

Depression Scales

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Comparison of Clinical Symptoms and Magnetic Resonance Angiographic (MRA) Results in Patients with Trigeminal Neuralgia and Persistent Idiopathic Facial Pain. Medium-Term Outcome after Microvascular Decompression of Cases with Positive MRA Findings

Cephalalgia ◽

10.1111/j.1468-2982.2005.01030.x ◽

2006 ◽

Vol 26 (3) ◽

pp. 266-276 ◽

Cited By ~ 41

Author(s):

A Kuncz ◽

E Vörös ◽

P Barzó ◽

J Tajti ◽

P Milassin ◽

...

Keyword(s):

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Facial Pain ◽

Clinical Symptoms ◽

Vascular Compression ◽

Term Outcome ◽

Persistent Idiopathic Facial Pain ◽

Venous Compression ◽

Imaging Results

To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.

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Cranial neuralgias and persistent idiopathic facial pain

Oxford Textbook of Headache Syndromes ◽

10.1093/med/9780198724322.003.0027 ◽

2020 ◽

pp. 237-247

Author(s):

Aydin Gozalov ◽

Messoud Ashina ◽

Joanna M. Zakrzewska

Keyword(s):

Neuropathic Pain ◽

Trigeminal Neuralgia ◽

Facial Pain ◽

Orofacial Pain ◽

Treatment Modalities ◽

Management Approach ◽

Trigeminal Neuropathy ◽

Facial Region ◽

Persistent Idiopathic Facial Pain ◽

Chronic Orofacial Pain

Orofacial pain is a complex problem and affects up to 7% of the population. Although trigeminal neuralgia has been considered the prime neuralgic condition in the facial region, other forms of neuropathic pain are now being more frequently recognized and require recognition and a different management approach. Many patients with chronic orofacial pain report numerous comorbidities, such as psychiatric or personality disorders, which significantly affect management. Various pain conditions present in the facial region. Some of them rarely present extra-orally (unless as radiating pain) such as atypical odontalgia or persistent dento-alveolar pain disorder and burning mouth syndrome, whereas others will present in both areas such as classical trigeminal neuralgia, post-traumatic trigeminal neuropathy, trigeminal neuropathy attributed to multiple sclerosis, and persistent idiopathic facial pain. Myofascial pain syndrome related to the muscles of mastication is very common and may also be associated with temporomandibular joint problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are similar in quality and characteristics with specific treatment modalities, but differ in pain location. Trigeminal neuropathic pain is caused most frequently by trauma. If no other diagnostic criteria are fulfilled, a diagnosis of persistent idiopathic facial pain is made. It is crucial for these patients to be managed by multidisciplinary teams.

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Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report

Journal of Pain Research ◽

10.2147/jpr.s193746 ◽

2019 ◽

Vol Volume 12 ◽

pp. 945-949 ◽

Cited By ~ 2

Author(s):

Brandon P. Staub ◽

Gianna Casini ◽

Edward A. Monaco III ◽

Raymond F. Sekula Jr ◽

Trent D. Emerick

Keyword(s):

Case Report ◽

Facial Pain ◽

Low Dose ◽

Persistent Idiopathic Facial Pain

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Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey

Health Education Journal ◽

10.1177/0017896911419350 ◽

2011 ◽

Vol 71 (6) ◽

pp. 662-669 ◽

Cited By ~ 10

Author(s):

Vishal R Aggarwal ◽

Amy Joughin ◽

Joanna Zakrzewska ◽

Priscilla Appelbe ◽

Martin Tickle

Keyword(s):

Primary Care ◽

Facial Pain ◽

Temporomandibular Disorder ◽

Postal Questionnaire ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Specialist Services ◽

Primary Care Practitioners ◽

Pain Symptoms ◽

The Uk

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire with four hypothetical clinical case scenarios describing sub-types of chronic oro-facial pain (COFP) was used to investigate diagnosis, treatment and referral options of GDPs. Results: Two hundred and twenty (44%) GDPs responded. The majority correctly diagnosed temporomandibular disorder (TMD; 88%) and burning mouth syndrome (BMS; 92%). There was more variation in the diagnosis of the other cases related to persistent oro-facial pain. For TMD there was a clear preference for treatment with occlusal splint therapy, and referral to a temporomandibular joint (TMJ) specialist. The BMS scenario showed drug therapy and referral to an oral medicine specialist to be most popular. The chronic oro-facial pain cases had greater variation in management and choice of psychotherapy was related to duration of pain symptoms. Conclusions: The greater variation in responses to scenarios based on patients with chronic oro-facial pain may reflect the difficulty clinicians face in diagnosing and treating this condition. Management appears to follow a biomedical model and most clinicians chose to refer patients for treatment. There are few specialist services to cater for such referrals, indicating a need to train primary care practitioners in management of chronic COFP, along with the establishment of evidence-based guidelines.

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