Department of Anesthesiology and Pain Management, Jeroen Bosch Ziekenhuis,'s Hertogenbosch, The Netherlands.
Pain Pract. 2009 Nov-Dec;9(6):443-8. doi: 10.1111/j.1533-2500.2009.00332.x.
Persistent idiopathic facial pain, previously known as atypical facial pain, is described as a persistent facial pain that does not have the classical characteristics of cranial neuralgias and for which there is no obvious cause (International Classification of Headache Disorders in 2004). According to these criteria, the diagnosis is possible if the facial pain is localized, present daily, and throughout all or most of the day. By definition, neurological and physical examination findings in persistent idiopathic facial pain should be normal. Forming a diagnosis is not simple and follows a process of elimination of other causes of facial pain. The precise incidence is unknown. The affliction is seen primarily in older adults and rarely in children. The pathophysiology is unknown. In persistent idiopathic facial pain, there is no abnormal processing of somatosensory stimuli in the pain area or facial area of the primary somatosensory cortex of the brain. The treatment is difficult and often requires a multidisciplinary approach. The most important part of the treatment is psychological counseling and pharmacological therapy. Pharmacological treatment with tricyclic antidepressants and anti-epileptic drugs can be tried. The conservative, pharmacological treatment with amitryptiline is the primary choice. Venlafaxine and fluoxetine treatment can also be considered. When the pharmacological treatment fails, pulsed radiofrequency treatment of the ganglion pterygopalatinum (sphenopalatinum) can be considered (2 C+).
持续性特发性面部疼痛，以前称为非典型面痛，被描述为一种持续性面部疼痛，没有颅神经痛的典型特征，且没有明显的病因（2004 年国际头痛疾病分类）。根据这些标准，如果面部疼痛局限、每天出现且持续全天或大部分时间，则可以做出诊断。从定义上讲，持续性特发性面部疼痛的神经学和体格检查结果应该正常。做出诊断并不简单，需要排除其他面部疼痛的原因。确切的发病率尚不清楚。这种疾病主要发生在老年人中，很少发生在儿童中。其病理生理学尚不清楚。在持续性特发性面部疼痛中，疼痛区域或大脑初级体感皮层的面部区域不存在体感刺激的异常处理。治疗较为困难，通常需要多学科方法。治疗的最重要部分是心理咨询和药物治疗。可以尝试使用三环类抗抑郁药和抗癫痫药进行药物治疗。采用保守的、药物治疗（阿米替林）是主要选择。也可以考虑文拉法辛和氟西汀治疗。当药物治疗失败时，可以考虑采用翼腭神经节（蝶腭神经节）的脉冲射频治疗（2C+）。
