An 80-year-old woman who moved into residential care 3 months ago is brought to your surgery. The elderly lady is complaining of an intense burning sensation affecting the right-hand side of her face which has been present for at least the past 3 months. The lower part of her face is spared. Nothing seems to make it better or worse. The patient is a poor historian and the carer knows little of her history before she came to live at the care home. On examination, you notice some scarring on the skin of her right cheek and forehead but nil else of note. The patient was recently prescribed a low dose of amitriptyline for anxiety by her GP and this seems to have helped a little with the pain.

Hey, fam! 🌟 Let’s break down this medical mystery in a way we can all understand! 🤓 So, we’ve got this sweet 80-year-old lady in a care home dealing with intense face pain on the right side! 😫 It’s been going on for 3 months, and nothing seems to make it better or worse. 😕 She’s a bit forgetful, but her carer noticed some scars on her right cheek and forehead. 🧐 Plus, she’s taking amitriptyline for anxiety, which kinda helps with the pain! 🙌 So what’s going on?

Some clues point to atypical facial pain – constant pain, no triggers, and a little help from amitriptyline! 🤔 But wait, there’s more – the pain’s got a specific spot, not touching the area of the trigeminal nerve! 🙅‍♀️ And that intense burning sensation? It screams postherpetic neuralgia! 🔥 The scarring on her face hints at previous herpes zoster – that’s a big clue! 📝 So, what’s the final verdict? 🤷‍♀️ Let’s put all the pieces together – atypical facial pain with a sprinkle of postherpetic neuralgia! 💥💔 We’ve cracked the case, fam! But stay tuned for more medical adventures! 🚀💙

RESEARCH

Atypical facial pain (AFP) is a type of facial pain that is characterized by persistent or recurrent pain in the face that does not fit the typical patterns of other facial pain syndromes such as trigeminal neuralgia (Koopman et al., 2009). It is considered a rare condition, but its exact incidence in the general population is not well established (Koopman et al., 2009). However, studies have shown that AFP is more common in women than men (Koopman et al., 2009).

Postherpetic neuralgia (PHN) is another type of facial pain that can occur after an episode of herpes zoster (shingles) (Koopman et al., 2009; Tolba et al., 2019). It is characterized by persistent pain in the area where the shingles rash occurred, even after the rash has healed (Tolba et al., 2019). The incidence of PHN has been studied in the general population, and it has been found to be relatively rare (Koopman et al., 2009). However, it is important to note that PHN can cause significant distress and compromise the quality of life for those affected (Jeon, 2016).

The diagnosis of AFP and PHN can be challenging, as there are no specific tests or imaging studies that can definitively confirm these conditions (Koopman et al., 2009). Diagnosis is typically based on clinical evaluation, medical history, and exclusion of other possible causes of facial pain (Koopman et al., 2009). In some cases, additional diagnostic procedures such as quantitative sensory testing or nerve blocks may be performed to aid in the diagnosis (Okayasu et al., 2014).

Treatment options for AFP and PHN vary depending on the severity and individual patient characteristics. Conservative management approaches may include medications such as anticonvulsants, antidepressants, and analgesics to help manage pain (Tolba et al., 2019; Akbaş et al., 2016). In some cases, interventional procedures such as sphenopalatine ganglion block, radiofrequency ablation, or neurostimulation may be considered (Ho et al., 2017; Tolba et al., 2019; Jeon, 2016). Surgical interventions, such as trigeminal tractotomy-nucleotomy or dorsal root entry zone operations, may be reserved for refractory cases (Bekar et al., 2020; Kanpolat et al., 2008).

Overall, AFP and PHN are distinct facial pain conditions that can significantly impact the quality of life of affected individuals. Accurate diagnosis and appropriate management are essential for providing relief and improving the well-being of patients experiencing these conditions. Further research is needed to better understand the incidence, etiology, and optimal treatment strategies for AFP and PHN.