Towards a new taxonomy of idiopathic orofacial pain.
There is no current consensus on the taxonomy of the different forms of idiopathic orofacial pain (stomatodynia, atypical odontalgia, atypical facial pain, facial arthromyalgia), which are sometimes considered as separate entities and sometimes grouped together. In the present prospective multicentric study, we used a systematic approach to help to place these different painful syndromes in the general classification of chronic facial pain. This multicenter study was carried out on 245 consecutive patients presenting with chronic facial pain (>4 months duration). Each patient was seen by two experts who proposed a diagnosis, administered a 111-item questionnaire and filled out a standardized 68-item examination form. Statistical processing included univariate analysis and several forms of multidimensional analysis. Migraines (n=37), tension-type headache (n=26), post-traumatic neuralgia (n=20) and trigeminal neuralgia (n=13) tended to cluster independently. When signs and symptoms describing topographic features were not included in the list of variables, the idiopathic orofacial pain patients tended to cluster in a single group. Inside this large cluster, only stomatodynia (n=42) emerged as a distinct homogenous subgroup. In contrast, facial arthromyalgia (n=46) and an entity formed with atypical facial pain (n=25) and atypical odontalgia (n=13) could only be individualised by variables reflecting topographical characteristics. These data provide grounds for an evidence-based classification of idiopathic facial pain entities and indicate that the current sub-classification of these syndromes relies primarily on the topography of the symptoms.
EA 3847, Faculté de Chirurgie Dentaire, CHU Clermont-Ferrand 63000, France INSERM E 0216, Neurobiologie de la Douleur Trigéminale, Clermont-Ferrand, France INSERM E-332, Hôpital Ambroise-Paré, APHP, Boulogne-Billancourt and Université Versailles Saint-Quentin, Versailles, France Faculté de Chirurgie Dentaire, Université Paris 5, Montrouge, France Faculté de Médecine Dentaire, Université Laval, Sainte-Foy, Que., Canada CHU, Saint-Etienne, France CHU, Clermont-Ferrand, France INSERM U525, Faculté de médecine, CHU, Nancy, France.
Alain
A
Woda
Stéphanie
S
Tubert-Jeannin
Didier
D
Bouhassira
Nadine
N
Attal
Bernard
B
Fleiter
Jean-Paul
JP
Goulet
Christelle
C
Gremeau-Richard
Marie Louise
ML
Navez
Pascale
P
Picard
Paul
P
Pionchon
Eliane
E
Albuisson
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003710:Demography; D003937:Diagnosis, Differential; D005157:Facial Pain / Q000145:classification* / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires