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Persistent Idiopathic Facial Pain (Previously “Atypical Facial Pain”)
Definition
Persistent idiopathic facial pain (PIFP), previously termed “atypical facial pain,” is a persistent facial pain that does not have the characteristics of cranial neuralgias and cannot be better attributed to a different disorder. Epidemiology
The prevalence of PIFP is far less frequent than that of trigeminal neuralgia (TN). Its prevalence in the general population is estimated at 0.03%. Its incidence is unknown. Pathophysiology
The literature suggests that abnormal sensitization of the trigeminal nociceptive system may play a crucial role in the development of PIFP. Clinical Features
Location, radiation: Generally, PIFP is limited to one particular area on one side of the face at
disease onset, is deep and poorly localized, and does not follow a neurological distribution.
Character: Nagging, aching, and dull, but can be sharp at times.
Severity: Varying often throughout the day from mild to moderate.
Duration and periodicity: Daily, and can be continuous or intermittent.
Factors affecting it: Stress, fatigue.
Associated factors: Often associated with other chronic pain conditions such as irritable bowel
syndrome , chronic widespread pain, headache, or back pain. Not associated with sensory loss
or other neurological deficits. Anxiety and depression, high catastrophizing, and impaired quality
of life are often associated with this condition.
Investigations
Radiographic imaging, cranial computed tomography (CT), or magnetic resonance imaging
(MRI) of the face and jaws do not demonstrate any relevant abnormality and are only indicated
if the history and examination suggest a need.
Copyright 2013 International Association for the Study of Pain There are very few randomized controlled trials, and most treatment choices are based on open-label studies. Tricyclic antidepressants such as amitriptyline (50–100 mg/day) or nortriptyline (20–50 mg) are effective if used for several months. Selective serotonin and norepinephrine reuptake inhibitors (duloxetine, venlafaxine, and mirtazapine) are used as well but are often ineffective. Patients benefit from simultaneous cognitive-behavioral therapy to improve their quality of life. References
[1] Aggarwal VR, McBeth J, Zakrzewska JM, Lunt M, Macfarlane GJ. The epidemiology of chronic syndromes that are frequently unexplained: do they have common associated factors? Int J Epidemiol 2006;35:468–76. [2] Forssell H, Tasmuth T, Tenovuo O, Hampf G, Kalso E. Venlafaxine in the treatment of atypical facial pain: a randomized controlled trial. J Orofac Pain 2004;18:131–7. [3] Harrison SD, Glover L, Feinmann C, Pearce SA, Harris M. A comparison of antidepressant medication alone and in conjunction with cognitive behavioural therapy for chronic idiopathic facial pain. Proceedings of the 8th World Congress on Pain. Seattle: IASP Press; 1997. p. 663–723. [4] Taiminen T, Kuusalo L, Lehtinen L, Forssell H, Hagelberg N, Tenovuo O, et al. Psychiatric (axis 1) and personality (axis 11) disorders in patients with burning mouth syndrome or atypical facial pain. Scand J Pain 2011;2:155–60. Copyright 2013 International Association for the Study of Pain

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