Atypical Facial Pain

THE CLINICAL SYNDROME

Atypical facial pain (also known as atypical facial neuralgia) is a term used to describe a heterogeneous group of pain syndromes that share in common the fact that the patient is suffering from facial pain that cannot be classified as trigeminal neuralgia. The pain is continuous but may vary in intensity. It is almost always unilateral and can be characterized as aching or cramping rather than shocklike neuritic pain typical of trigeminal neuralgia. The vast majority of patients suffering from a typical facial pain are female. The distribution of pain is in the distribution of the trigeminal nerve but invariably overlaps divisions of the nerve.

Patients with atypical facial pain will often rub the affected areas; those with trigeminal neuralgia will not.

Headache often accompanies the pain of atypical facial pain and is clinically indistinguishable from the pain of tension-type headache. Stress is often the precipitating or exacerbating factor in the development of a typical facial pain. Depression and sleep disturbance are also present in a significant number of patients suffering from atypical facial pain. A history of facial trauma, infection, or tumor of the head and neck may be elicited in some patients with atypical facial pain, but in most cases, no precipitating even can be identified.

SIGNS AND SYMPTOMS

The table below compares atypical facial pain with trigeminal neuralgia, which is characterized by sudden paroxysms of neuritic shocklike pain, then pain of atypical facial pain is constant and of a dull, aching quality, but it may vary in intensity. The pain of trigeminal neuralgia is always within the distribution of a division of the trigeminal nerve, whereas the pain of atypical facial pain will invariably overlap these divisional boundaries. The trigger areas that are characteristic of trigeminal neuralgia are absent in patients suffering from atypical facial pain. The clinical symptomatology of atypical facial pain may often be confused with pain of dental or sinus origin or may be erroneously characterized as trigeminal neuralgia. Careful questioning and physical examination will usually allow the clinician to distinguish these overlapping pain syndromes. Tumors of the zygoma and mandible as well as posterior fossa tumors and retropharyngeal tumors may produce illdefined pain that may be attributed to atypical facial pain, and these potentially life-threatening diseases must be carefully searched for in any patient with facial pain. Reflex sympathetic dystrophy of the face should also be considered in any patient presenting with ill-defined facial pain after trauma, infection, or central nervous system injury. The pain of atypical facial pain is dull and aching in character, whereas the pain of reflex sympathetic dystrophy of the face is burning in nature with significant allodynia often present. Stellate ganglion block ma help distinguished the two pain syndromes, as the pain of reflex sympathetic dystrophy of the face readily responds to this sympathetic nerve block, whereas atypical facial pain does not. The pain of atypical facial pain must be distinguished from the pain of jaw claudication associated with temporal arteritis.

Treatment

The mainstay of atypical facial pain is the combination of pharmacologic treatment with tricyclic antidepressants and physical modalities such as oral orthotic devices and physical therapy. Trigeminal nerve block and intra-articular injection of the temporomandibular joint with small amounts of local anesthetic and steroid may also be of value. Antidepressant compounds such as nortriptyline at a single bedtime dose of 25 mg will help normalize sleep disturbance and treat underlying myofascial pain syndrome. Orthotic devices help the patient avoid jaw clenching and bruxism, which may exacerbate the clinical syndrome. Management of underlying depression and anxiety is mandatory if the clinician hopes to help relieve the symptoms of atypical facial pain.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.