Foreman Peter A
Queen Elizabeth Hospital, Rotorua.
N Z Dent J. 2008 Jun;104(2):44-8.
Most orofacial pain originates in the oral cavity and the surrounding structures. However, advances in the understanding of pain neurophysiology have shown that convergent afferent nociceptive transmissions from non-trigeminal, extraoral sources can enter the trigeminal system. This may confuse the diagnosis by presenting as (or contributing to) dental, sinus, temporomandibular and other head and neck pains. Incorrect diagnoses may lead to inappropriate and/or invasive procedures, creating further problems. Professor Richard Kroening (former Director of the UCLA Pain Management Center) repeatedly emphasised the maxim that "without correct diagnosis, there can be no prognosis". My own areas of special interest have included acute pain management (anaesthesia and conscious sedation) and chronic orofacial pain. I have seen many dental patients who have been referred to multidisciplinary pain management clinics, often after years of failed treatment attempts. More recent experience as a member of a hospital team evaluating long term ACC patients with many types of persistent pain problems again confirms the premise that accurate diagnosis is critical if management is to be successful.
大多数口腔面部疼痛起源于口腔及周围结构。然而，对疼痛神经生理学认识的进展表明，来自非三叉神经、口外来源的汇聚性传入伤害性信号传导可进入三叉神经系统。这可能会因表现为（或导致）牙齿、鼻窦、颞下颌及其他头颈部疼痛而使诊断变得复杂。错误的诊断可能导致不恰当和/或侵入性的治疗手段，从而引发更多问题。理查德·克罗宁教授（加州大学洛杉矶分校疼痛管理中心前主任）反复强调“没有正确的诊断，就没有预后”这一格言。我自己特别感兴趣的领域包括急性疼痛管理（麻醉和清醒镇静）以及慢性口腔面部疼痛。我见过许多牙科患者，他们常常在经过多年治疗尝试失败后被转介到多学科疼痛管理诊所。作为医院团队成员评估患有多种持续性疼痛问题的长期ACC患者的最新经历再次证实了这样一个前提，即如果要成功进行治疗，准确的诊断至关重要。
