Atypical Facial Pain
For many years, atypical facial pain (AFP) represented a group of disorders that included most of the facial pain disorders that did not fit into the category of classic trigeminal neuralgia. As our understanding of the pathophysiology of the many facial pain disorders increased, a new classification for facial pain was developed that reflected this new knowledge. Thus, terms that were unnecessarily general were abandoned in favor of terminology that was more specific. Currently, AFP is reserved for facial pain of psychogenic origin.
The symptoms of AFP can be quite variable. Patients may describe burning, aching, cramping, pinching, or pulling sensations. Commonly, symptoms exceed the confines of the trigeminal nerve distribution or are bilateral in nature.
The diagnosis of AFP is made following a formal psychological evaluation, including a battery of psychometric tests. Additionally, other causes of facial pain, such as injuries to the trigeminal nerve or trigeminal neuralgia, must be excluded.
Patients with AFP are thought to have psychological origins of their pain. Depression, unresolved conflicts, behavioral problems, or other psychological issues may result in AFP.
Since the pain from AFP is psychogenic in origin, psychological support, including ongoing counseling if necessary, is the appropriate treatment. It is important for both the patient and the treating physician to realize that surgery is completely inappropriate for the treatment of this condition.