Persistent Idiopathic Facial Pain

Persistent Idiopathic Facial Pain

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Persistent idiopathic facial pain (PIFP), originally known as atypical facial pain, refers to pain along the territory of the trigeminal nerve that does not fit the classic presentation of other cranial neuralgias. [1, 2] The pain is usually of long duration, lasting most of the day (if not continuous), is unilateral, and is without autonomic signs or symptoms. It is described as a severe ache, crushing sensation, or burning sensation. Upon examination and workup, no abnormality is noted.

Within the group of chronic facial pain syndromes, PIFP represents a particular diagnostic challenge. Patients frequently are misdiagnosed or attribute their pain to a prior event, such as a dental procedure or facial trauma. Psychiatric symptoms of depression and anxiety are prevalent in this population, further compounding the diagnostic conundrum. Treatment of PIFP is typically less effective than that of other facial pain syndromes, and a multidisciplinary approach is required to address the many facets of this pain syndrome.

For patient education resources, see the Brain and Nervous System Center, as well as Trigeminal Neuralgia (Facial Nerve Pain).

The Headache Classification Subcommittee of the International Headache Society defines PIFP as follows [3] :

Pain is in the face

Pain is present daily and persists for all or most of the day

Pain is confined at onset to a limited area on one side of the face and is deep and poorly localized

In addition, the pain is not associated with sensory loss or other physical signs, with no abnormalities in laboratory or imaging studies

PIFP usually does not have a specific cause; however, injury of the trigeminal nerve proximally or distally may lead to this disorder. Demyelination, either central or peripheral, may initiate PIFP symptoms. Infectious causes should also be considered.

Because of a lack of agreement on classification criteria, accurate figures on the frequency of PIFP are difficult to obtain. The estimated incidence has been estimated to be 1 case per 100,000 population (0.001%), though this number may be an underestimate. [4] A German study that included 3336 participants estimated the lifetime prevalence of PIFP to be 0.03%. [5]

PIFP mainly affects adults and is rare in children. [4] Overall, the disorder affects both sexes approximately equally, but more women than men seek medical care. [4]

For patients who do not respond to the available pharmacologic and nonpharmacologic therapies, the prognosis is poor.

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Stanley J Krolczyk, DO, RPh Associate Professor, Director of Multiple Sclerosis Center, Department of Neurology, University of South Florida College of Medicine

Stanley J Krolczyk, DO, RPh is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Osteopathic Association, American Headache Society

Disclosure: Received grant/research funds from TEVA for clinical trials; Received consulting fee from TEVA for speaking and teaching; Received consulting fee from EMD SERONO for speaking and teaching; Received consulting fee from BIOGEN for speaking and teaching; Received grant/research funds from EMD SERONO for clinical trials; Received consulting fee from Novartis for speaking and teaching; Received grant/research funds from NOVARTIS for clinical trials.

Martin A Myers, MD University of South Florida College of Medicine

Disclosure: Nothing to disclose.

Kavita Kalidas, MD Assistant Professor, Department of Neurology, University of South Florida College of Medicine

Kavita Kalidas, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Pain Society

Disclosure: Nothing to disclose.

Robert A Egan, MD NW Neuro-Ophthalmology

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec and Genentech for participation on Advisory Boards.

Joseph Carcione Jr, DO, MBA Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans

Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Persistent Idiopathic Facial Pain

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