Tait Raymond C, Ferguson McKenzie, Herndon Christopher M
Saint Louis University School of Medicine, St. Louis, USA.
Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, USA.
J Pain Manag Med. 2017 Mar;3(1). Epub 2017 Jan 30.
Chronic orofacial pain is a symptom associated with a wide range of neuropathic, neurovascular, idiopathic, and myofascial conditions that affect a significant proportion of the population. While the collective impact of the subset of the orofacial pain disorders involving neurogenic and idiopathic mechanisms is substantial, some of these are relatively uncommon. Hence, patients with these disorders can be vulnerable to misdiagnosis, sometimes for years, increasing the symptom burden and delaying effective treatment. This manuscript first reviews the decision tree to be followed in diagnosing any neuropathic pain condition, as well as the levels of evidence needed to make a diagnosis with each of several levels of confidence: definite, probable, or possible. It then examines the clinical literature related to the idiopathic and neurogenic conditions that can occasion chronic orofacial pain, including burning mouth syndrome, trigeminal neuralgia, glossopharyngeal neuralgia, post-herpetic neuralgia, and atypical odontalgia. Temporomandibular disorders also are examined as are other headache conditions, even though they are not neurologic conditions, because they are common and can mimic symptoms of the latter disorders. For each of these conditions, the paper reviews literature regarding incidence and prevalence, physiologic and other contributing factors, diagnostic signs and symptoms, and empirical evidence regarding treatments. Finally, in order to improve the quality and accuracy of clinical diagnosis, as well as the efficiency with which effective treatment is initiated and delivered, criteria are offered that can be instrumental in making a differential diagnosis.
慢性口面部疼痛是一种与多种神经性、神经血管性、特发性和肌筋膜疾病相关的症状，这些疾病影响着相当一部分人群。虽然涉及神经源性和特发性机制的口面部疼痛障碍子集的总体影响很大，但其中一些相对不常见。因此，患有这些疾病的患者可能容易被误诊，有时长达数年，这会增加症状负担并延迟有效治疗。本文首先回顾了诊断任何神经性疼痛疾病时应遵循的决策树，以及以不同置信水平（明确、可能或可能）进行诊断所需的证据水平。然后，它研究了与可能导致慢性口面部疼痛的特发性和神经源性疾病相关的临床文献，包括灼口综合征、三叉神经痛、舌咽神经痛、带状疱疹后神经痛和非典型牙痛。颞下颌关节紊乱症以及其他头痛疾病也在研究范围内，尽管它们不是神经系统疾病，但由于它们很常见且可能模仿后者疾病的症状。对于这些疾病中的每一种，本文回顾了有关发病率和患病率、生理及其他促成因素、诊断体征和症状以及治疗的经验证据的文献。最后，为了提高临床诊断的质量和准确性，以及启动和提供有效治疗的效率，本文提供了有助于进行鉴别诊断的标准。
