Persistent idiopathic facial pain, a diagnosis and treatment of challenge. Case report

IntroductionBorderline personality disorder may be associated with persistent facial pain since its relationship with different pain syndromes has been reported. Persistent idiopathic facial pain is commonly unilateral, pulsating, burning, or profound and challenging for clinicians. Therefore, excluding underlying organic causes by appropriate clinical investigation and complementary tests is essential to diagnose this disease.Objective This case report aimed to provide evidence of the relationship between idiopathic persistent facial pain and borderline personality disorder.Case report A 24-year-old woman reported severe pain in the left hemiface for ten months, three to six hours per day, five days per week. No abnormalities were found in dental and neurological assessments. A psychiatric evaluation was performed, and the patient met the criteria for borderline personality disorder. Pharmacological treatment consisted of daily lithium carbonate (900 mg) and venlafaxine (150 mg). Weekly sessions of cognitive-behavioral therapy with emotional regulation and tolerance to stress were performed. The patient was evaluated every 30 days and showed improved pain intensity and frequency over six months. Conclusion Proper management of borderline personality disorder can modify the evolution of persistent idiopathic facial pain when both pathologies are comorbidities.

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Sphenopalatine Ganglion Electrical Nerve Stimulation Implant for Intractable Facial Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e403 ◽

2015 ◽

Vol 3;18 (3;5) ◽

pp. E403-E409

Author(s):

Foad Elahi

Keyword(s):

Case Report ◽

Pain Relief ◽

Local Anesthetic ◽

Nerve Stimulation ◽

Facial Pain ◽

Pain Clinic ◽

Sphenopalatine Ganglion ◽

Electrical Nerve Stimulation ◽

Persistent Idiopathic Facial Pain ◽

Electrical Neuromodulation

Persistent idiopathic facial pain can be extremely difficult and significantly challenging to manage for the patient and the clinician. Pharmacological treatment of these painful conditions is not always successful. It has been suggested that the autonomic reflex plays an important role in the pathophysiology of headaches and facial neuralgia. The key structure in the expression of cranial autonomic symptoms is the sphenopalatine ganglion (SPG), also known as the pterygopalatine ganglion. The role of the SPG in the pathophysiology of headaches and facial pain has become clearer in the past decade. In this case report, we describe a 30-year-old woman with insidious onset of right facial pain. She was suffering from daily pain for more than 9 years prior to her visit at the pain clinic. Her pain was constant with episodic aggravation without a predisposing trigger factor. The patient was evaluated by multiple specialties and tried multimodal therapy, which included antiepileptic medications, with minimal pain relief. A SPG block using short-acting local anesthetic provided significant temporary pain relief. The second and third attempt of SPG block using different local anesthetic medications demonstrated the same responses. After a thorough psychological assessment and ruling out the presence of a correctable cause for the pain, we decided to proceed with SPG electrical neuromodulation. The patient reported significant pain relief during the electrical nerve stimulation trial. The patient underwent a permanent implant of the neurostimulation electrode in the SPG region. The patient was successfully taken off opioid medication and her pain was dramatically responsive during a 6-month follow-up visit. In this article we describe the SPG nerve stimulation and the technical aspect of pterygopalatine fossa electrode placement. The pterygoplatine fossa is an easily accessible location. This case report will be encouraging for physicians treating intractable facial pain by demonstrating a novel therapeutic option. This report shows a minimally invasive approach to the SPG. Key words: Sphenopalatine ganglion, persistent idiopathic facial pain, electrical neuromodulation

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Glomus Tumor of the Cheek: A Case Report

Case Reports in Medicine ◽

10.1155/2012/307294 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Konstantinos Veros ◽

Konstantinos Markou ◽

Chrysa Filitatzi ◽

Dionysios E. Kyrmizakis

Keyword(s):

Case Report ◽

Histological Examination ◽

Facial Pain ◽

Glomus Tumor ◽

Diagnosis And Treatment ◽

Complete Excision ◽

Glomus Tumors

Glomus tumors are benign, subcutaneous neoplasms of the perivasculature. Though facial location is rare, the diagnosis of a glomus tumor should be considered in cases of undiagnosed painful facial nodules or chronic facial pain. Imaging aids in defining the tumor and planning a complete excision in order to avoid recurrence. Histological examination is mandatory after every attempted excision. A case of glomus tumor of the cheek along with the possible pitfalls of diagnosis and treatment and a brief review of the limited associated literature are presented.

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