A 65-year-old woman complained of a deep-seated aching sensation affecting the right-hand side of her face from her top jaw up to her forehead. She has suffered from the pain more or less continuously for about 4 years. There are no exacerbating or ameliorating factors. Analgesics have proved ineffective. Her GP referred her to an ENT consultant who carried out an MRI to check for sinus problems. She has also been seen by two other dentists and had root canal treatment on several teeth, two of which have subsequently been extracted. On examination, you detect no abnormalities.

So, what’s the dealio? Drumroll, please… It’s atypical facial pain! 💥🎉 The pain is constant, doesn’t get worse or better, and there are no triggers. Classic atypical vibes! 💯 We throw in an MRI just to make sure, but honestly, it’s mostly for reassurance. 🙌

Basically, it’s chronic face pain without any obvious causes. 🙅‍♀️ The diagnosis is like playing detective – ruling out other possible causes first! 🔍 This condition can be tricky since exams and tests often come back normal. 🤔 So, what’s the deal with treatment? It’s not a walk in the park! 😬 Docs try different approaches like meds, nerve blocks, physical therapy, even alternative therapies! 🌿💊 But here’s the kicker – evidence for their effectiveness is limited, and more research is needed!

RESEARCH

Atypical facial pain is a condition characterized by chronic facial pain without any identifiable structural or specific causes (Maarbjerg et al., 2016). It is often diagnosed based on the patient’s history, absence of neurological and radiological signs, and negative imaging results (Derbyshire et al., 1994). The pain is typically described as dull, aching, or nagging, and it may be continuous or intermittent (Deun et al., 2020). Atypical facial pain is considered a diagnosis of exclusion, meaning that other potential causes of facial pain must be ruled out before making this diagnosis (Deun et al., 2020).

Patients with atypical facial pain often present with normal neurological, radiological, and dental examination findings (Derbyshire et al., 1994). This can make the diagnosis challenging, as there are no specific tests or imaging studies that can definitively confirm the presence of atypical facial pain (Benoliel & Gaul, 2017). However, it is important to conduct a thorough evaluation to rule out other possible causes of facial pain, such as dental issues, temporomandibular disorders, sinusitis, and neuropathic conditions (Goel et al., 2015).

The exact etiology of atypical facial pain is not well understood. Traumatic neuropathic mechanisms are suspected to play a role in the development of the condition (Benoliel & Gaul, 2017). It has been suggested that the pain may be related to dysfunctional pain processing in the central nervous system (Weiss et al., 2017). Psychological factors, such as stress and anxiety, may also contribute to the development and maintenance of atypical facial pain (Mykletun et al., 2006).

Treatment for atypical facial pain is often challenging and may require a multidisciplinary approach. The goal of treatment is to alleviate pain and improve the patient’s quality of life. Various treatment modalities have been used, including medications, nerve blocks, physical therapy, cognitive-behavioral therapy, and alternative therapies such as acupuncture (Weiss et al., 2017; Naik et al., 2014). However, the evidence for the effectiveness of these treatments is limited, and more research is needed to determine the optimal approach for managing atypical facial pain (Weiss et al., 2017).

In conclusion, atypical facial pain is a chronic condition characterized by facial pain without any identifiable structural or specific causes. It is diagnosed based on the patient’s history, absence of neurological and radiological signs, and negative imaging results. The exact etiology of atypical facial pain is not well understood, but traumatic neuropathic mechanisms and dysfunctional pain processing in the central nervous system are suspected to play a role. Treatment for atypical facial pain is challenging and often requires a multidisciplinary approach. Further research is needed to improve our understanding of the condition and develop more effective treatment strategies.

References:

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