Persistent Idiopathic Facial Pain

Pain Practice

Volume 9 Issue 6, Pages 443 - 448, Published Online: 27 Oct 2009, © 2009 by World Institute of Pain

EVIDENCE-BASED MEDICINE

Evidence-Based Interventional Pain Medicine according to Clinical Diagnoses

Paul Cornelissen, MD*; Maarten van Kleef, MD, PhD, FIPP ^† ; Nagy Mekhail, MD, PhD, FIPP ^‡ ; Miles Day, MD, FIPP, DABIPP ^§ ; Jan van Zundert, MD, PhD, FIPP ^†¶

*Department of Anesthesiology and Pain Management, Jeroen Bosch Ziekenhuis,'s Hertogenbosch, The Netherlands; ^† Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; ^‡ Pain Management Department Cleveland Clinic, Cleveland, Ohio, U.S.A.; ^§ Department of Anesthesiology and Pain Management Texas Tech University HSC, Lubbock, Texas, U.S.A.; ^¶ Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium

Correspondence to Maarten van Kleef, MD, PhD, FIPP, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl.

ABSTRACT

Persistent idiopathic facial pain, previously known as atypical facial pain, is described as a persistent facial pain that does not have the classical characteristics of cranial neuralgias and for which there is no obvious cause (International Classification of Headache Disorders in 2004). According to these criteria, the diagnosis is possible if the facial pain is localized, present daily, and throughout all or most of the day. By definition, neurological and physical examination findings in persistent idiopathic facial pain should be normal. Forming a diagnosis is not simple and follows a process of elimination of other causes of facial pain.

The precise incidence is unknown. The affliction is seen primarily in older adults and rarely in children. The pathophysiology is unknown. In persistent idiopathic facial pain, there is no abnormal processing of somatosensory stimuli in the pain area or facial area of the primary somatosensory cortex of the brain.

The treatment is difficult and often requires a multidisciplinary approach. The most important part of the treatment is psychological counseling and pharmacological therapy. Pharmacological treatment with tricyclic antidepressants and anti-epileptic drugs can be tried. The conservative, pharmacological treatment with amitryptiline is the primary choice. Venlafaxine and fluoxetine treatment can also be considered.

When the pharmacological treatment fails, pulsed radiofrequency treatment of the ganglion pterygopalatinum (sphenopalatinum) can be considered (2 C+).