Burchiel Kim J
Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon 97239, USA.
Neurosurgery. 2003 Nov;53(5):1164-6; discussion 1166-7. doi: 10.1227/01.neu.0000088806.11659.d8.
A patient-oriented classification scheme for facial pains commonly encountered in neurosurgical practice is proposed.
This classification is driven principally by the patient's history.
The scheme incorporates descriptions for so-called "atypical" trigeminal neuralgias and facial pains but minimizes the pejorative, accepting that the physiology of neuropathic pains could reasonably encompass a variety of pain sensations, both episodic and constant. Seven diagnostic labels result: trigeminal neuralgia Types 1 and 2 refer to patients with the spontaneous onset of facial pain and either predominant episodic or constant pain, respectively. Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery, whereas trigeminal deafferentation pain results from injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an intentional attempt to treat either trigeminal neuralgia or other facial pain. Postherpetic neuralgia follows a cutaneous herpes zoster outbreak (shingles) in the trigeminal distribution, and symptomatic trigeminal neuralgia results from multiple sclerosis. The final category, atypical facial pain, is synonymous with facial pain secondary to a somatoform pain disorder. Atypical facial pain can be suspected but not diagnosed by history and can be diagnosed only with detailed and objective psychological testing.
This diagnostic classification would allow more rigorous and objective natural history and outcome studies of facial pain in the future.
提出一种针对神经外科实践中常见面部疼痛的以患者为导向的分类方案。
该分类主要由患者病史驱动。
该方案纳入了对所谓“非典型”三叉神经痛和面部疼痛的描述，但尽量减少了贬义性，因为认识到神经性疼痛的生理机制可能合理地涵盖各种疼痛感觉，包括发作性和持续性的。由此产生了七个诊断标签：三叉神经痛1型和2型分别指面部疼痛自发发作且主要为发作性或持续性疼痛的患者。三叉神经性疼痛是由创伤或手术对三叉神经的意外损伤引起的，而三叉神经去传入性疼痛是在有意治疗三叉神经痛或其他面部疼痛时，通过外周神经消融、神经节溶解或神经根切断术对神经造成损伤所致。带状疱疹后神经痛发生在三叉神经分布区域的皮肤带状疱疹（带状疱疹）发作之后，症状性三叉神经痛由多发性硬化症引起。最后一类，非典型面部疼痛，与躯体形式疼痛障碍继发的面部疼痛同义。非典型面部疼痛可通过病史怀疑但不能确诊，只有通过详细和客观的心理测试才能确诊。
这种诊断分类将使未来对面部疼痛的自然史和结局研究更加严谨和客观。
