FAQ’s on Facial Pain
What are the symptoms of facial pain?
The spectrum of facial pain is wide, and the clinical presentation can vary from mild tenderness, to severe and shocking pain. The exact description of the pain will depend on the underlying condition, so you should be as detailed as possible when your physician asks you to describe the pain.
Facial pain from acute injury to the tissues is usually throbbing, and accompanied by tenderness on palpation. The intensity of the pain will vary with the severity of the injury. Pain from herpes zoster is localized to the affected nerve and is described as severe shooting pain that occurs with even the lightest touch. Pain from trigeminal neuralgia has been described as a “shock-like” pain that rapidly shoots through the face and can be debilitating.
What causes facial pain?
Facial pain can be caused by a variety of things. These include nerve damage, infection, and physical injury. Diseases such as herpes zoster (shingles), myofascial pain syndrome, sinusitis, or tooth abscesses can also cause facial pain. Other conditions such as temporomandibular joint dysfunction syndrome or trigeminal neuralgia can also cause facial pain. Idiopathic (no identifiable cause) facial pain has also been noted to occur.
The exact pathogenesis of facial pain will depend on the underlying conditions. Acute injury causes damage to the muscles and soft tissues, leading to pain. Pain from trigeminal neuralgia can be caused by progressive damage around the branches of the trigeminal nerve or central pathogenic mechanisms. It is recommended that you consult a physician to identify the cause of the pain.
When should I seek consult?
The threshold for consulting will depend on your tolerance for pain and the severity of the pain. However, it should be noted that if the pain in the face is accompanied by pain on the chest, shoulder or neck, or if the pain is associated with difficulty breathing and chest tightness, you should seek medical consult as soon as possible, as these may be signs of a myocardial infarction (heart attack).
How is facial pain diagnosed?
Diagnosis of facial pain is made after a complete medical history and physical examination. If the cause is not evident, then additional examinations may be requested such as dental and sinus X-rays, Computerized Tomography (CT) scans, and Magnetic Resonance Imaging (MRI) scans. Neurological tests are also employed to assess damage to nerves.
How is facial pain treated?
The definitive management of facial pain is to address the underlying symptoms. Symptomatic
relief can also be afforded by medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, and corticosteroid injections. If the underlying cause is from infection, you will have to complete a course of antibiotics to achieve relief.
Surgery may be indicated if the pain is structural in origin, such as from tumors. Pain from neuralgia can be treated with a variety of novel approaches, such as percutaneous radiofrequency thermoregulation, stereotactic radiosurgery and botulinum injections.
As much as possible, it is advisable to opt for non-surgical treatment unless indicated. There are risks associated with surgery, such as infection or intraoperative damage to the muscles and nerves.
Parmar M, Sharma N, Modgill V, Naidu P. (2013). Comparative Evaluation of Surgical Procedures for Trigeminal Neuralgia. Journal of Maxillofacial and Oral Surgery. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24431878
Reddy VK, Parker SL, Lockney DT, et al. (2013). Percutaneous Stereotactic Radiofrequency Lesioning for Trigeminal Neuralgia: Determination of Minimum Clinically Important Difference in Pain Improvement for Patient Reported Outcomes. Neurosurgery. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24335815
Sabalys G, Juodzbalys G, Wang HL. (2013). Aetiology and Pathogenesis of Trigeminal Neuralgia: a Comprehensive Review. Journal of Oral and Maxillofacial Research. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/24422020