Weiss Austin L, Ehrhardt Ken P, Tolba Reda
Anesthesiology Department, Louisiana State University Health Science Center, New Orleans, LA, USA.
Pain Management Center, Anesthesiology Department, Ochsner Health System, New Orleans, LA, USA.
Curr Pain Headache Rep. 2017 Feb;21(2):8. doi: 10.1007/s11916-017-0609-9.
The purpose of this article is to focus on an excruciating disorder of the face, named atypical facial pain or persistent idiopathic facial pain (PIFP). It is considered an underdiagnosed condition with limited treatment options. Facial pain can be a debilitating disorder that affects patients' quality of life. Up to 26% of the general population has suffered from facial pain at some point in their lives. It is important to highlight the different types of facial pain to be able to properly manage this condition accordingly.
Newer interventional modalities such as pulsed radiofrequency ablation (PFR) of the sphenopalatine ganglion, peripheral nerve field stimulators (PNFS), and botulinum toxin injections have promising results. In summary, more prospective studies such as randomized controlled trials are necessary to explore the possibility of their more widespread use as viable procedures for the treatment of PIFP. In this review article, we describe the workup and diagnosis of PIFP and highlight recent literature regarding the pathophysiology and treatment of PIFP. PIFP is an excruciating disorder of the face often misdiagnosed as trigeminal neuralgia (TN) However, unlike TN symptoms, the pain is persistent rather than intermittent, usually unilateral, and without autonomic signs or symptoms. When a clinician encounters a patient with neuropathic facial pain whose symptoms are incongruent with the more common etiologies, the diagnosis of atypical facial pain must be entertained. Treatment of PIFP is multidisciplinary. Unfortunately, few randomized controlled trials for the treatment of PIFP exist. However, there are a select number of pharmacological, non-pharmacological, and interventional treatment options that have proven to be moderately effective.
本文旨在聚焦一种令人痛苦的面部疾病,称为非典型面部疼痛或持续性特发性面部疼痛(PIFP)。它被认为是一种诊断不足且治疗选择有限的疾病。面部疼痛可能是一种使人衰弱的疾病,会影响患者的生活质量。高达26%的普通人群在其生命中的某个时刻曾遭受过面部疼痛。强调不同类型的面部疼痛以便能够相应地妥善管理这种疾病很重要。
较新的介入治疗方式,如蝶腭神经节的脉冲射频消融(PFR)、周围神经场刺激器(PNFS)和肉毒杆菌毒素注射,都有很有前景的结果。总之,需要更多的前瞻性研究,如随机对照试验,来探索它们更广泛地用作治疗PIFP可行方法的可能性。在这篇综述文章中,我们描述了PIFP的检查和诊断,并强调了有关PIFP病理生理学和治疗的最新文献。PIFP是一种令人痛苦的面部疾病,常被误诊为三叉神经痛(TN)。然而,与TN症状不同,疼痛是持续性的而非间歇性的,通常为单侧,且无自主神经体征或症状。当临床医生遇到一名患有神经性面部疼痛但其症状与更常见病因不符的患者时,必须考虑非典型面部疼痛的诊断。PIFP的治疗是多学科的。不幸的是,很少有针对PIFP治疗的随机对照试验。然而,有一些药物、非药物和介入治疗选择已被证明有一定疗效。