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Other conditions that can cause chronic face pain

Persistent idiopathic facial pain (atypical facial pain)

The name ‘atypical facial pain’ has been used in the past but, as nobody has been able to define ‘typical’ facial pain, this is no longer considered an appropriate term. This is now called either persistent idiopathic facial pain or chronic idiopathic facial pain. To be given this name, the face pain must have lasted for more than three months, have no identifiable cause and not respond to usual pain relief medications. Persistent idiopathic facial pain can come and go or it can be continuous. It varies in intensity and can last for many years. It might affect a small part of the face or the whole of the face and mouth. People often describe the pain as nagging, throbbing or aching.

Persistent idiopathic facial pain is often experienced by people who have pain in other parts of the body, such as the pain caused by irritable bowel syndrome. It can also be experienced by people with itchy skin.

Stress does not cause chronic idiopathic facial pain but it can make the pain worse. People might experience increased pain during times of change or difficult times in their lives, such as moving house, changing jobs or a relationship breaking up.

There are no tests available to help diagnose persistent idiopathic facial pain so doctors rely on people offering accurate and specific descriptions of their symptoms.

Atypical odontalgia (trigeminal neuropathic pain or persistent dento-alveolar pain disorder)

dental problems, which would be the usual or ‘typical’ cause. People with atypical odontalgia experience a dull ache or severe discomfort in one or more of their teeth or in their gums where they previously had teeth. It can start after dental treatment such as a filling, root canal treatment or having a tooth extracted. The pain might move from one tooth to another. Touching the affected area can worsen the pain. Some people describe the pain as a burning pain or pins and needles.

Atypical odontalgia is not caused by problems with the teeth or gums, even though it may feel like this. Dental treatment or tooth removal will not stop the pain. It is a nerve-type pain (neuropathic) and, as with many types of face pain, it is the nerve signal mechanism that has become faulty.

Burning mouth syndrome

Burning mouth syndrome (BMS) is the name for a condition that causes a burning sensation or changes in the sensation in the tongue or other parts of the mouth. People with burning mouth syndrome might experience an unpleasant taste in their mouth or a feeling that they have too much or too little saliva. They might also feel some numbness in the mouth. Dentures, crowns and bridges might become so uncomfortable that it is impossible for people to wear them, even after adjustments. Burning mouth syndrome mainly affects women around the menopause but it can affect men and women of any age.

It is thought that burning mouth syndrome is a type of neuropathic pain caused by damage to the small nerves supplying the tongue and mouth. Studies have shown that the nerves are not transmitting information correctly.

There is no specific test to check for this condition but some people will have a burning sensation which is caused by other factors. For this reason, a dental or medical specialist will carry out a thorough examination of the mouth to rule out other possible causes of discomfort, such as thrush (a yeast infection also known as candida). They will also check whether any drugs or medication currently being taken could be the cause. Blood tests might be carried out to check for conditions such as diabetes, anaemia and vitamin deficiencies.

What are the treatments for persistent idiopathic facial pain, atypical odontalgia and burning mouth syndrome?

There are no surgical treatments for these conditions. The treatments used are medication and developing ways to manage the pain (see Pain management section).

Pain relief drugs such as paracetamol, aspirin or ibuprofen do not usually help people with persistent face pain. People are often prescribed antidepressant or anticonvulsant (anti-seizure) medication. Being prescribed antidepressants does not mean that someone thinks the person with pain is depressed. Research has shown that some anticonvulsants and antidepressants might help to reduce pain by decreasing the number of pain signals reaching the brain.

Nortriptyline is the antidepressant that is most commonly prescribed for face pain. It might need to be taken for several months before it becomes fully effective and for a year for people to experience lasting benefit. As with many drugs for pain, it can help some people but not others.

People taking nortriptyline rarely experience any serious side effects. People might experience mild drowsiness, a dry mouth or constipation. Nortriptyline is not suitable for everyone.

Pain management

Having strategies for coping with pain flare ups is crucial to reduce fear and the risk of depression. Because the pain is invisible, the public rarely appreciate its intensity or the significant impact it has on people's lives.

Persistent pain can affect people in many different ways. People might find that they struggle with being at work or have to stop working, their social lives can reduce and they stop enjoying their usual activities. It is common for people to worry about what is happening in their face and body and to be concerned that the pain is caused by damage. Some people might change the way they approach activities such as eating, moving their face or jaw and sometimes their upper body. This can lead to reduced fitness, weak muscles and stiff joints which can make activity even harder and everyday tasks increasingly difficult. People often say that they feel angry, frustrated, low in mood and lacking in confidence as a result of their pain. These effects can make pain harder to live with. People can find themselves trapped in unhelpful cycles that can be hard to break and leave them feeling stuck.

Pain management is a self-management approach. It involves the person with pain learning new skills to help them reduce the effect (or impact) that the pain has on them and their life. A self-management approach can be useful alongside ongoing medical treatment or if medical treatment has been stopped because it does not reduce or get rid of the pain. At this point, the self-management approach can be a very helpful alternative way of managing persistent face pain.

Clinical psychologists and physiotherapists help people to develop pain management skills. Pain management sessions can be one-to-one or in a group. The sessions will not help to cure your pain but they can help many people in different ways. For example, they can help people to:

  • understand their persistent face pain;
  • carry on with their everyday activities more easily and without necessarily experiencing an increase in their pain;
  • return to activities which they used to enjoy but have stopped because of the pain;
  • learn how to manage times of increased pain;
  • improve their mood and confidence about doing things even though they have pain;
  • feel more confident in their ability to manage their pain;
  • work towards short-term and long-term goals such as eating crunchy food, going out for meals and returning to work or college.

Self-management of pain can result in a more enjoyable and fulfilling life despite having persistent face pain. These services might not be available in your area but if you talk to your GP they might be able to refer you to a service elsewhere.

The British Pain Society has produced some useful publications for patients about pain management (see Further reading and Useful contacts sections).

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