What is Chronic Facial Pain?Chronic facial pain is used to describe any pain felt in the face or neck area and is commonly caused by problems with a person’s jaw, such as repeated clenching of the jaw or grinding of the teeth, or a misaligned bite.
Utilizing multiple treatment modalities offers the most success in treating chronic facial pain. Chronic facial pain occurs in many people, and can have a variety of causes. Some causes for chronic facial pain include migraine headaches, dental problems, temperomandibular joint (TMJ) dysfunction, and neuropathic facial pain. A common neuropathic pain in the face is called trigeminal neuralgia. The trigeminal nerve is the fifth cranial nerve, and is responsible for communicating sensory information to the brain. Trigeminal neuralgia is an irritation, or inflammation of the trigeminal nerve, and may be triggered by multiple every day activities including smiling, eating, or brushing the teeth.
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The trigeminal nerve has three branches, affecting three different aspects of the face. One, or several of these branches can be the culprit. Identifying the correct nerve is vital to establishing a treatment plan. Another bundle of nerves responsible for some facial pain conditions is called the sphenopalatine ganglion. The sphenopalatine ganglion sits directly behind the nose, and may be implicated in pain that occurs in various aspects of the face, primarily in the front. Many headaches are caused by irritation of the sphenopalatine ganglia.
Neuropathic chronic facial pain may also originate from the occipital nerves, in a condition called occipital neuralgia. This type of pain generally originates from the back of the head, and can radiate to the face. Atypical facial pain is usually idiopathic, meaning that there is no known cause. Atypical chronic facial pain usually occurs in one side of the face, and symptoms are present for most of the day, every day. The diagnosis of atypical chronic facial pain is generally made after more common causes are excluded.
Disorders of the temporomandibular joint, or TMJ, frequently cause significant chronic facial pain. A TMJ is located on either side of your mouth and connects the mandible, or your lower jaw, to your skull in both places. Surrounding the TMJ are facial muscles, nerves and blood vessels which can be affected by any injury or disorder of the joint.
The National Institute of Dental and Craniofacial Research estimates that more than 10 million Americans are affected by TMJ disorders, with the condition occurring more frequently in women than in men. Results from a study called Orofacial Pain: Prospective Evaluation and Risk Assessment (OPPERA) indicated that the risk for chronic TMJ disorders peaks in a woman’s childbearing years and decreases thereafter.
Symptoms of a TMJ disorder may include pain or tenderness in the jaw, an aching pain around the ear, difficulty chewing, facial pain, headaches, neck and shoulder pain, dizziness, hearing loss, or a locking of the joint. TMJ disorders sometimes also mean that movement of the jaw is accompanied by a clicking sound.
Diagnosis for TMJ usually involves a bite test, in which the physician asks the patient to bite down or clench the teeth and reference the areas in which pain is felt. Treatment options include biofeedback, pain killers, strength-building exercises for the facial muscles, orthodontics, reconstructive dentistry and surgical repositioning of the jaw.
Because TMJ disorders usually affect not only the bones but also the nerves and muscles, it is frequently necessary for a treatment to involve multiple health care disciplines, such as dentistry and neurology.
Other causes of chronic facial pain include cancer or other disease, headaches, injury, infection, dental diseases or damage to the mouth, and neurological disorders, such as trigeminal neuralgia, which originate with problems with the nerves and nervous system.
Chronic Facial Pain TreatmentMigraine pain is usually treated by utilizing one or more migraine medications, typically a prophylactic and an abortive medication (please see the section on headaches for more discussion of this). Dental pain is usually treated by removing or treating the offending agent, however there are some injections that might be helpful as well. TMJ pain can be treated by steroid injections directly into the joint, as well as TMJ splints, chiropractic treatments, and medications, usually an anti-inflammatory such as ibuprofen. Neuropathic facial pain can be treated by trigeminal nerve blocks, occipital nerve blocks, and sphenopalatine ganglion blocks. Some medications used for neuropathic facial pain include anti-inflammatories, anticonvulsants (gabapentin, carbamazepine), antidepressants (Cymbalta, Savella, amitriptylline), and occasionally opioids (hydrocodone), and opioid-like medications (tramadol). Neuropathic facial pain is also commonly treated by neuromodulation, such as a spinal cord stimulator or a peripheral nerve stimulator.
A study done by Slavin and Colpan, et al (2006) showed that 73% of patients who underwent peripheral nerve stimulator trials received pain relief of 50% or more. Of the patients who underwent permanent placement of peripheral nerve stimulators, some received relief so significant that they actually went on to have the system removed several years later. These results indicate that neuromodulation is extremely efficacious in the treatment of facial pain. Utilizing multiple treatment modalities offers the most success in treating this very painful condition.
- Chan-Liao, Mingi. Sphenopalatine Ganglion Block- A Simple But Underutilized Therapy for Pain Control. Retrieved February 15, 2010 from: http://www.pain-manage.org.tw/s-pain/s-pain05.htm Krolczyk, Stanley (2010)
- Persistent Idiopathic Facial Pain: Differential Diagnoses & Workup. Retrieved February 15, 2010 from:http://emedicine.medscape.com/article/1142187-diagnosis Slavin, K., Colpan, E. , Munawar, N., et al (2006).
- Trigeminal and Occipital Peripheral Nerve Stimulation for Craniofacial Pain. Retrieved February 16, 2010 from: http://www.medscape.com/viewarticle/554865 The Mayo Clinic (2009). Trigeminal Neuralgia. Retrieved February 15, 2010