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EDITORIAL
Year : 2015  |  Volume : 29  |  Issue : 1  |  Page : 1

Atypical facial pain: Is it still a diagnostic wastebasket?


Department of Oral Medicine and Radiology, ACPM Dental College, Dhule, Maharashtra, India

Date of Web Publication1-Dec-2014

Correspondence Address:
Ujwala R Newadkar
Department of Oral Medicine and Radiology, ACPM Dental College, Dhule - 424 003. Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-5333.145900

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How to cite this article:
Newadkar UR. Atypical facial pain: Is it still a diagnostic wastebasket?. Indian J Pain 2015;29:1

How to cite this URL:
Newadkar UR. Atypical facial pain: Is it still a diagnostic wastebasket?. Indian J Pain [serial online] 2015 [cited 2019 Oct 18];29:1. Available from: http://www.indianjpain.org/text.asp?2015/29/1/1/145900

Pain is the number one reason people seek health care; it is deemed the ''fifth vital sign,'' to mark its importance as health status indicator. [1] Orofacial pain refers to a large group of disorders, including temporomandibular disorders (TMDs), headaches, neuralgia, pain arising from dental or mucosal origins, and idiopathic pain. [2],[3] Atypical facial pain (AFP) is a diagnosis of exclusion for pain not meeting the diagnostic criteria of other facial pain problems. It has been considered to represent a psychological disorder although no specific diagnostic criteria have ever been established. AFP is defined more by what it is not than by what it is. Due to the vagueness of this term and in an attempt to avoid further confusion, the International Association for the Study of Pain discontinued to list AFP in their classification of chronic pain. [4] Instead the broader term AFP has been replaced by two specific subentities or, depending on the view, closely related conditions, namely "atypical odontalgia" (phantom tooth pain) and "glossodynia and sore mouth" (oral dysesthesia); [4] the latter of these is also referred to as, "burning mouth syndrome." [5] However, in a clinical environment the term AFP is still widely accepted, and in agreement with the mainstream of the literature. Diseases that have to be taken into consideration in the differential diagnoses of AFP include trigeminal neuralgia and other craniofacial neuralgias, cluster and other vascular headaches, TMDs, postherpetic neuralgia, temporal arteritis, painful diseases located in the teeth, jaws, or maxillary sinus, disorders of the cervical spine and the cervical musculature, neoplasia of the maxillary sinus or nasopharynx, diseases of the central nervous system, (projected pain), and pain of psychological origin. [6],[7] Clinical decision-making thus requires knowledge of neuroanatomy and physiology, a thorough review of patient-reported history and symptoms, and a comprehensive clinical examination with relevant and targeted clinical diagnostic testing, supplemented by laboratory tests if needed. [8] AFP is considered the least manageable form of chronic pain. [9] A multidisciplinary approach of therapy involving different specialties, including dentistry, neurology, otorhinolaryngology, and psychology/psychiatry, is indicated.

 
  References Top

1.
Lanser P, Gesell S. Pain management: The fifth vital sign. Healthc Benchmarks 2001;8:68-70.  Back to cited text no. 1
    
2.
Agostoni E, Frigerio R, Santoro P. Atypical facial pain: Clinical considerations and differential diagnosis. Neurol Sci 2005;26 Suppl 2:s71-4.  Back to cited text no. 2
    
3.
Madland G, Newton-John T, Feinmann C. Chronic idiopathic orofacial pain: I: What is the evidence base? Br Dent J 2001;191:22-4.  Back to cited text no. 3
    
4.
Merskey H, Bogduk N. Classification of Chronic Pain. 2 nd ed. Seattle: IASP Press; 1994. p. 59-60.  Back to cited text no. 4
    
5.
Ship JA, Grushka M, Lipton JA, Mott AE, Sessle BJ, Dionne RA. Burning mouth syndrome: An update. J Am Dent Assoc 1995;126:842-53.  Back to cited text no. 5
    
6.
Greenberg MS, Glick M. Burket's Oral Medicine Diagnosis & Treatment. 10 th ed. Hamilton, Ontario: BC Decker Inc.; 2003.  Back to cited text no. 6
    
7.
Hunter S. Atypical facial pain - rewarding to treat. Practitioner 1994;238:186-90, 193.  Back to cited text no. 7
    
8.
Haanpää M, Attal N, Backonja M, Baron R, Bennett M, Bouhassira D, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152:14-27.  Back to cited text no. 8
    
9.
Sprotte G. Gesichtsschmerz. In: Zenz M, Jurna I, editors. Lehrbuchder Schmerztherapie. Stuttgart: Wissenschaftliche Verlagsgesellschaft; 1993. p. 405-16.  Back to cited text no. 9
    




 

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