Pain Maps from Facial Pain Patients Indicate a Broad Pain Geography

Abstract

Two hundred consecutive female patients, who were referred to a university-based facial pain clinic, were asked to mark all painful sites on sketches showing the contours of a human body in the frontal and rear views. The drawings were analyzed with transparent templates containing 1875 (frontal view) and 1929 (rear view) square cells of equal size. The average patient scored 71.8 cells in the frontal and 99.7 cells in the rear view (corresponding to 3.8% and 5.2% of the maximum possible scores). In individual patient drawings, however, up to 42.7% and 44.9% of all cells were marked. Only 37 cases (18.5%) exhibited pain that was limited to the trigeminal system. An analysis of the pain distribution according to the arrangements of dermatomes revealed three distinct clusters of patients: (1) pain restricted to the region innervated by the trigeminal nerves (n = 37); (2) pain in the trigeminal dermatomes and any combination involving the spinal dermatomes C2, C3, and C4, but no other dermatomes (n = 32); and (3) pain sites involving dermatomes in addition to the ones listed above (n = 131). Mean ages in the three clusters were 38.7, 35.5, and 37.5 years, respectively (p = 0.62, n.s.). Widespread pain existed for longer durations (median, 48 months) than conditions involving local and regional pain (median, 24 months) (p = 0.02, s.). Our findings showed that among a great percentage of persistent facial pain patients the pain distribution is more widespread than commonly assumed, and that the persistence of pain in the regional and widespread pain presentations is significantly greater than in cases with pain limited to the trigeminal system.

Craniofacial Pain and Motor Function: Pathogenesis, Clinical Correlates, and Implications

“…It is essential to distinguish between patients with recently acquired pain from patients with long-established persistent pain. Individual pain distribution of musculoskeletal craniofacial pain falls into one of three clusters that consist of (a) the region involving the trigeminal dermatomes, (b) the trigeminal and upper cervical dermatomes, and (c) pain sites in addition to those listed above (Turp et al, 1998a). Because patients with TM disorders and widespread pain were least tolerant of pain experimentally induced by cutaneous electrical stimulation over the masseter muscles (Hagberg, 1991), differences in peripheral mechanisms and/or central neural processing between subjects with different pain distributions should be expected.…”

Mapas de dor corporal aprimoram os relatos das queixas dolorosas em pacientes com dor orofacial

“…Our results confirm previous findings that regions of greater pain reports are located in the upper body areas, both for males and females. However, 69% to 76% of TMD patients also present pain outside of head and facial regions 2,14 . A correlation between OFP and referred pain in other body parts is also described in the literature.…”

“…Although the screening protocols of OFP patients include questions about the presence of pain in adjacent facial areas such as head, neck, ears and shoulders, the other body areas are rarely considered by dental professionals. Previous studies have reported an association between OFP and general pain conditions [2][3][4][5][6][7] . An example of those relationships is fibromyalgia, which, if not known, may difficult a successful OFP treatment 8 .…”

“…An important information to be identified in chronic pain patients is pain distribution and how it is felt 9 . Human body schemes, in which patient draws the specific location and distribution of pain areas, have been useful for diagnosing and treating several chronic pain conditions 2,9,10 . It is suggested that by using body pain maps there is a greater possibility of patients indicating other pain areas -out of face -that could not have been reported by them in the chief complaint.…”

Medical conditions and body pain in patients presenting orofacial pain

“…Pain drawings: After the interview, patients were requested to mark all pain sites on a sketch of the human body. Nine potential pain sites (head, face, neck, shoulders, arms, chest, abdomen, back, and legs) could be distinguished 9,10 . statistical analysis Descriptive statistics were used to characterize the sample, considering the number of medical conditions and painful areas mentioned by individuals.…”