Facial Pain

Strong pain in the face or  facial region is some of the worst form of pain from which one can suffer. Nine out of ten patients with chronic facial pain also suffer from psychological problems from their condition.

Acute facial pain is most often caused by inflammation or infection, and are most appropriately dealt with by a dentist, dental surgeon, ENT-specialist, or eye doctor. (By eye doctor, we are referring to a medical doctor with expertise in treating eye disorders, not optometrists who usually issue prescriptions for glasses.)

Logically, one would start with a visit to the dentist first. Should the dentist be uncertain as to the cause of the pain you may request a referral to a dental surgeon either from your dentist, or your regular physician.

Should this not yield any results, an ENT specialist or surgeon should be consulted. If the pain persists the involvement of a pain specialist at a relatively early stage may be advisable, if only to get an assessment.

Long term facial pain may be due to one of the following:

(Of course there are other specific conditions. The ones listed here are only those that are most common.)

Neuropathic pain:

This is also a component of most of the conditions mentioned below. Neuropathy means sick nerve.  All nerves that send pain from the face to the brain  may become sick, injured, severed an accident or surgery, infected, or affected by cancer. There are many ways a patient may perceive neuropathic pain, and its distribution will to a degree depend on where they have been affected and which nerves are involved the damage.  In other words, the definition provided here is only a generic one. Neuropatic pain may affect virtually all parts of the body, not just the face. It is mentioned here because it does play an important role in facial pain and patients afflicted with facial pain may hear of their pain being described as neuropathic in

nature. 

There are many treatments for neuropathic pain. Your doctor, or ideally a pain specialist should be involved in its treatment.

Trigeminal neuralgia:

Trigeminal neuralgia. This is a neuropathic pain condition that manifests itself as 'lightning' strikes in the face. The nerve becomes sensitised (see chronic pain) and the pain may be triggered or worsened by such activities as light touch to the skin or mucous membranes. Examples of such light touch are hugging, brushing one's teeth or simply eating. All activities one cannot do without. The pain is usually eased by carbamazepine, Tegretol in most countries; or other medicines normally used to control epilepsy.

The most effective and long lasting  treatment, used worldwide, is pulsed radiofrequency treatment. (Read more about this technique elsewhere on the web site.)

Many neurosurgeons inject glycerol directly into the nerve tissue. This may give a good soothing effect. The true cause of the pain is often difficult to pinpoint. Sometimes a blood vessel irritates the nerve, then surgery is an option.

As a patient, make sure you have all the information about the treatment you are about to undergo both from your regular physician as well as the specialist performing the procedure.

Disease of the jaw joint:

The jaw joint contains connective tissue called a discus. This may become dislodged and then slips in and out of normal anatomical position. When it moves in and out of its correct position a clicking or snapping noise may be heard. If it has been completely been degenerated and destroyed, a crushing sound is often heard when moving the jaw. 

This is a very common condition. Approximately 40% of adults have dysfunction of the jaw joint to some extent. Fortunately, most of the time it does not lead to pain.

Pain in the jaw joint is usually located, in the forward section, inside the ear canal. Moreover,  jaw joint irritation may be the cause of strong muscle contractions and pain in the muscles needed for chewing. The muscles of the jaw are very strong for their size and long term tension may lead to damage and premateure wear on the teeth. It will also lead to increased strain on the connective tissue disc in the jaw joint.

Often one clenches his teeth while asleep without being aware of it. Then he may awaken with a severe, 'pounding' tension headache particularly surrounding the temples. Often, then it is beneficial to get a dentist to have a 'bite plate' made. It alone may relieve and prevent this type of head and face ache.

Referred pain in facial pain:

The nerves for pain sensation in the neck and those for the face are 'neighbors' in the nervous system. Therefore, the body sometimes "gets it wrong" and transfers pain that should have registered as neck pain in the brain as facial pain. There are numerous examples of what structures in the face may be affected by pain that should have been registered as neck pain. For instance, pain in the eyelids, or even the teeth may be the result of a problem that lies not in the face, but neck. In such cases treatments such as pulsed radiofrequency, or others should be directed to the problem in the neck.  Doctors should be very mindful of this, particularly, when the cause of facial pain is hard to pin down. Patients may also take an active role in asking their physician if the pain could be coming from somewhere else, especially when invasive procedures are considered.

Atypical facial pain:

This is a neuropathic pain originating in a structure known as the sphenopalatine ganglion. A ganglion is a connection point where many nerves meet, much like a 'train station' for messages- The sphenopalatine ganglion is a mixed ganglion which means that it contains different types of nerves that carry different types of messages, to carry on with my train analogy: "there are passenger trains and freight trains each arriving, departing , and exhanging passengers and cargo."

The pain nerves in the sphenopalatine ganglion come from the trigeminal nerve. Because of the destinations this nerve serves, the pain from the sphenopalatine ganglion may be located in the upper jaw, back of the throat, in or around the eye, in the forehead, in the sinuses, in the forehead, the temples, and so on.

It is often accompanied by red on the white part of the eye, flow of tears, and a stuffy nose. Peripheral ectopic activity in the sphenopalatine ganglion is frequently caused by pain in the neck. (see the article on chronic pain.)

The diagnosis of showing that the sphenopalatine ganglion is involved in the pain is performed by the injection of a local anesthetic in the ganglion, with pain disappearing temporarily.

The most effective treatment following diagnosis is pulsed radiofrequency.

Horton's Migraine:

Horton's Migraine is an intermittent sphenopalatineneuralgia. Attacks of pain behave in a typical manner. It sets in suddenly and lasts for up to two hours. There may be multiple occurences in the course of a twenty four hour period. Attacks tend to take place particularly at night. Such pain attacks may continue for months, and then go away for months. This type of migraine headache is frequently also referred to as a cluster headache. For a long time ut was believed that this aliment was more common in males than females; However this theory has been debunked.

The diagnosis is made on the typical pains, and the pattern in which they behave. It may be possible to confirm the diagnosis with a diagnostic block with a local anesthethic. (see other sections of the web page.)

The attacks may be treated with migraine medicines. Pulsed Radiofrequency treatment may offer a more long term solution in patients who get positive effects from that treatment.

Deafferentation pain:

These are also called phantom pains and are the result of a nerve being severed, or otherwise seriously damaged. An example are pains felt in limbs that have been amputated. Although many other causes may be implicated.

If you suffer from one of the listed conditions, or another type of facial pain or condition, should you desire, you may of course contact the offices of  Dr. Stokke, or another pain specialist, to see if he can be of assistance.