References:
1: Burchiel KJ. A new classification for facial pain. Neurosurgery.
2003 Nov;53(5):1164-6; discussion 1166-7.
Department of Neurological Surgery, Oregon Health and Science University,
Portland, Oregon 97239, USA. burchiek@ohsu.edu
PURPOSE: A patient-oriented classification scheme
for facial pains commonly encountered in neurosurgical practice
is proposed.
CONCEPT: This classification is driven principally
by the patient's history.
RATIONALE: The scheme incorporates descriptions
for so-called "atypical" trigeminal neuralgias and facial
pains but minimizes the pejorative, accepting that the physiology
of neuropathic pains could reasonably encompass a variety of pain
sensations, both episodic and constant. Seven diagnostic labels
result: trigeminal neuralgia Types 1 and 2 refer to patients with
the spontaneous onset of facial pain and either predominant episodic
or constant pain, respectively. Trigeminal neuropathic pain results
from unintentional injury to the trigeminal nerve from trauma or
surgery, whereas trigeminal deafferentation pain results from injury
to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy
in an intentional attempt to treat either trigeminal neuralgia or
other facial pain.
Postherpetic neuralgia follows a cutaneous herpes zoster outbreak
(shingles) in
the trigeminal distribution, and symptomatic trigeminal neuralgia
results from
multiple sclerosis. The final category, atypical facial pain, is
synonymous with
facial pain secondary to a somatoform pain disorder. Atypical facial
pain can be suspected but not diagnosed by history and can be diagnosed
only with detailed and objective psychological testing.
CONCLUSION: This diagnostic classification would
allow more rigorous and objective natural history and outcome studies
of facial pain in the future.
2. Graff-Radford SB. Facial pain. Curr Opin Neurol. 2000
Jun;13(3):291-6. .
The Pain Center, Los Angeles, CA 90048, USA.
Facial pain is a debilitating disorder if left untreated. Too often
patients are
labelled as having psychopathology when face pain etiology is unclear.
These
patients are categorized as 'atypical', 'idiopathic' or 'psychogenic'.
Idiopathic, when referring to a medical problem suggests that there
is something unknown, and does not define the problem. The same
applies to terms incorporating the word 'atypical'. It is postulated
that the most commonly undiagnosed facial pain conditions include
neuropathic and myofascial pains because their pathophysiologies
are not well understood. Peripheral and central mechanisms associated
with these disorders are used to provide an update of these frequently
seen clinical conditions.
