Facial pain unit, Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust, 256 Gray's Inn Road, London, WC1X 8LD, UK.
J Headache Pain. 2013 Apr 25;14(1):37. doi: 10.1186/1129-2377-14-37.
Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
口腔颌面部疼痛在其最广泛的定义中可影响高达 7%的人群。其诊断和初步管理由牙医和医生负责，在二级保健领域由疼痛医师、头痛神经科医生和口腔医生负责。慢性面部疼痛是一种长期疾病，与所有其他慢性疼痛一样，与许多合并症相关，治疗结果通常与呈现的合并症相关，如抑郁、焦虑、灾难化和存在其他慢性疼痛，这些必须作为管理的一部分加以解决。大多数口腔颌面部疼痛是持续性的，因此间歇性疼痛史可缩小鉴别诊断范围。有一些特定的口腔疾病很少出现口腔外表现，如非典型牙源性疼痛和灼口综合征，而其他疾病则会同时出现在口腔内外。与咀嚼肌相关的肌肉骨骼疼痛非常常见，也可能与椎间盘问题有关。三叉神经痛和更罕见的舌咽神经痛是具有明确治疗途径的特定诊断。其他与神经病变相关的三叉神经病理性疼痛最常见于创伤，但也需要考虑恶性肿瘤、感染和自身免疫等继发性原因。治疗遵循其他神经病理性疼痛的原则，使用公认的药物治疗，并辅以心理支持。如果没有其他诊断标准，则诊断为慢性或持续性特发性面部疼痛，通常抗抑郁药和认知行为疗法联合使用有效。面部疼痛患者应由多学科团队管理。
