When does the face hurt – what is idiopathic facial pain?

Idiopathic facial pain has many causes. Fortunately, she is amenable to treatment.

Persistent idiopathic pain is more common than other types of facial pain. At present, it is believed to be a polyetiological syndrome, but the most important of these causes are surgical manipulation in the maxillofacial region and chronic stress.

Usually, such people are unsuccessfully treated by various medical specialists – dentists, orthodontists, ophthalmologists, otolaryngologists, neurosurgeons, psychiatrists, and they never manage to give them a correct diagnosis. This type of facial pain is treatable, but patience and persistence are required from the doctor and the patient.

Pain without a reason

Facial pains are quite common – according to data from various sources, their prevalence among the population is from 17 to 26%, and 7-11% are chronic.

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Idiopathic, that is, without a cause, this type of facial pain is called because the diagnosis is made by the method of exclusion. The exact prevalence of persistent idiopathic facial pain /PILB/ is unknown, but according to observations of foreign and Bulgarian specialists, 60-70% of those affected are middle-aged women.

In specialized medical centers, patients with PILB are found more often than those with trigeminal neuralgia /differential diagnosis is carried out with this clinical condition/.

But most people with such a health problem first seek help from a dentist or orthodontist. In Germany, for example, among patients with facial pain, trigeminal neuralgia is overdiagnosed in 83% of cases and PILB is underdiagnosed in 100% of cases.

As a result of incorrect diagnosis, patients undergo surgical interventions, very often repeated – ¼ lose 1 or more teeth before the correct diagnosis is made.

How to recognize PILB?

Persistent idiopathic facial pain is usually unilateral, but can be bilateral and persistent. Patients describe it as dull, deep or burning.

“Neurological examinations usually do not detect neurological disorders, such as a decrease in sensitivity in the painful area or weakness of the facial muscles – German neurologists point out. – moreover, the detection of such a pathology in the neurological status excludes the diagnosis of PILB.”

The appearance of the disease can be preceded by a surgical operation carried out in this area, trauma to the face, teeth or gums.

An important diagnostic criterion is the discrepancy of pain from the area of ​​innervation from the branches of the trigeminal nerve. Most often, painful sensations are localized in the area of ​​the upper jaw and can also spread to the periorbital area, nose, cheeks and jaw.

Pain can migrate from one part of the face to another and be accompanied by a sensation of “mucous movement” in the sinuses. In a significant proportion of patients, the pain can spread to the head, neck and even arms.

In some cases, the pain is localized in one tooth and is called atypical odontalgia. Although facial pain persists throughout the day, it is usually absent, and 50-70% of patients experience sleep disturbances. By nature, the pain is dull, deep, exhausting.

Unlike neuralgia, severe pain attacks are atypical for patients with persistent idiopathic facial pain, and trigger points are absent. Aggravation of pain can be caused by cold, psychological stress, and also by surgical and dental manipulations.