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Atypical Facial Pain

What is Atypical Facial Pain – Diagnosis – Treatment

Atypical Facial Pain

Pain sensation from the face, the teeth, the gums, the tongue, and the frontal portion of the scalp is carried by a pair of trigeminal nerves. Motor fibers supply the chewing muscles, a tiny muscle that change the eardrum tension, and a few small muscles in the mouth floor. Motor function, obviously, has nothing to do with the pain but it’s important in the diagnosis of trigeminal nerve disorders.

The diagnosis and management of atypical facial pain is challenging. Some doctors believe that it is a warning sign of trigeminal neuralgia. Others perceive this pain as psychogenic.

Atypical facial pain pain may occur in any part of the face, in the gums, or in the teeth. This pain is mild-to-moderate in intensity and occurs usually daily or always daily. There is no specific type of pain. It may be felt as pressure, aching, burning, shooting, or any other type of pain. The vast majority of patients report no pain at night. Atypical facial pain tends to stay in the same location.

Diagnostic work up finds nothing wrong. Multiple dental evaluations and procedures have no effect on the pain.
Please note that any pain syndrome produced by some dental or surgical procedure has nothing to do with this phenomenon of unexplained chronic facial pain. These patients often have those procedures done in attempt to get rid of the pain.
Conventional pain medications often are only marginally effective. Medications, normally used for neuropathic pain, are sometimes effective. Some pains respond to trigeminal neuralgia treatment protocols.

Here is an example of an atypical facial pain:
A few years ago a middle-aged lady came to my office. She had a four year history of a persistent, annoying pain in the left mid-upper jaw. She had no evidence of anxiety, depression, or any other chronic pain syndrome. She felt absolutely exhausted by this pain. Three teeth were removed with zero effect on the pain. She sought a neurology opinion simply because she had nowhere else to go. Her exam and diagnostic work up were normal. Having little optimism, I tried Gabapentin. Surprisingly, she came a week later, stating that it was her first week with no pain for the past 4 years. It worked like a magic wand. It offered a complete pain control with permanent remission after about 18 months.
Unfortunately, happy end is not the rule. There is always a reason for any pain but the cause of this elusive chronic facial pain is hard to find most of the time. Even in this case the cause of the pain remained unknown.