Orofacial pain for clinicians: A review of constant and attack-like facial pain syndromes

Abstract

Background Primary headache syndromes such as migraine are among the most common neurological syndromes. Chronic facial pain syndromes of non-odontogenic cause are less well known to neurologists despite being highly disabling. Given the pain localization, these patients often consult dentists first who may conduct unnecessary dental interventions even if a dental cause is not identified. Once it becomes clear that dental modalities have no effect on the pain, patients may be referred to another dentist or orofacial pain specialist, and later to a neurologist. Unfortunately, neurologists are also often not familiar with chronic orofacial pain syndromes although they share the neural system, i.e., trigeminal nerve and central processing areas for headache disorders. Conclusion In essence, three broad groups of orofacial pain patients are important for clinicians: (i) Attack-like orofacial pain conditions, which encompass neuralgias of the cranial nerves and less well-known facial variants of primary headache syndromes; (ii) persistent orofacial pain disorders, including neuropathic pain and persistent idiopathic facial/dentoalveolar pain; and (iii) other differential diagnostically relevant orofacial pain conditions encountered by clinicians such as painful temporomandibular disorders, bruxism, sinus pain, dental pain, and others which may interfere (trigger) and overlap with headache. It is rewarding to know and recognize the clinical picture of these facial pain syndromes, given that, just like for headache, an internationally accepted classification system has been published and many of these syndromes can be treated with medications generally used by neurologists for other pain syndromes.

Evaluating the Influence of Acute and Chronic Orofacial Pains on the Overall Comprehensive Quality of Life

“…In the United States, they account for 21% of visits to accident and emergency rooms and contribute to 25% of yearly job absenteeism, resulting in a large increase in the economic burden. OFP is directly associated with higher levels of daily productivity loss and overutilisation of healthcare resources [ 6 , 7 ]. The occurrence rate of OFP varies from 17 to 26%, with up to 11% classified as chronic orofacial pain (COFP) [ 8 ].…”

Advancements in Understanding and Classifying Chronic Orofacial Pain: Key Insights from Biopsychosocial Models and International Classifications (ICHD-3, ICD-11, ICOP)

“…In response to the complexities presented by chronic pain, particularly in the orofacial region, this review seeks to illuminate the various dimensions of chronic orofacial pain (COFP) [16,17]. The face and mouth hold special significance in human physiology and social interaction, making pain in this region particularly complex [18,19].…”