Atypical Facial Pain
David Elpern M.D., Williamstown, MA, USA
on September 30, 2004
Department of Neurological Surgery, Oregon Health and Science University,
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.
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