Cancer and Referred Facial Pain

Abstract

Orofacial pain may be a symptom of diverse types of cancers as a result of local or distant tumor effects. The pain can be presented with the same characteristics as any other orofacial pain disorder, and this should be recognized by the clinician. Orofacial pain also can arise as a consequence of cancer therapy. In the present article, we review the mechanisms of cancer-associated facial pain, its clinical presentation, and cancer therapy associated with orofacial pain.

Cancer and orofacial pain

“…Since sometimes pain can be the single symptom of cancer and in some cases it can be the first symptom of cancer, or a symptom of later stages, it needs to be underscored that pain itself should not be used as the only diagnostic criteria for cancer. Cancer pain diagnosis is made by exclusion and only can be reached after a thorough medical history, and all the common etiologies have been carefully investigated and ruled out (3). When in doubt, always seek the referral to an orofacial pain specialist for further evaluation.…”

“…Different mechanisms are involved in the pathophysiology of cancer pain (3,4). Cancer cells have the ability to infiltrate nerves along the epineural, perineural and endoneural space, inducing tissue infiltration and nerve damage, and this is known as perineural invasion (PNI) (5,6) and is associated with tumor progression and local recurrence (6,7).…”

“…Paraneoplastic neuropathies or paraneoplastic syndrome refers to signs and symptoms similar to an autoimmune response that attacks the nervous system as a result of the presence of cancer, but not as a result of the local mass (3). These types of neuropathies are rare in the orofacial region (51), but trigeminal pain with a history of diarrhea and astenia has been reported in response to small cell lung carcinoma (52).…”

“…Orofacial pain can arise as a symptom of regional or distant cancers resulting from nociceptive/somatic, neuropathic, inflammatory and visceral mechanisms (1-3). It is important to underscore that the characteristics of the pain can imitate the symptomatology of any orofacial pain disorder with descriptors of dull, aching, sharp, shooting, stabbing, burning, pulling, and throbbing pain, and refer pain to any craniofacial structure regionally or from a distant site (3).…”

“…It is important to underscore that the characteristics of the pain can imitate the symptomatology of any orofacial pain disorder with descriptors of dull, aching, sharp, shooting, stabbing, burning, pulling, and throbbing pain, and refer pain to any craniofacial structure regionally or from a distant site (3). Therefore, the clinician needs to be aware of the diverse orofacial pain disorders and to understand that cancer pain must be included in the differential diagnosis of patients with unexplained and intractable orofacial pain.…”