Diferential diagnosis in atypical facial pain: a clinical study.
OBJECTIVE
To evaluate a sample of patients with atypical facial pain (AFP) in comparison to patients with symptomatic facial pain (SFP).


METHODS
41 patients with previous diagnostic of AFP were submitted to a standardized evaluation protocol, by a multidisciplinary pain team.


RESULTS
21 (51.2%) were considered AFP and 20 (48.8%) (SFP) received the following diagnosis: 8 (40.0%) had temporomandibular disorders (TMD); 3 (15.0%) had TMD associated to systemic disease (fibromyalgia, systemic erythematosus lupus); 4 (20.0%) had neuropathy after ear, nose and throat (ENT) surgery for petroclival tumor; 2 (10.0%) had Wallenberg syndrome; 1 (5.0%) had intracranial tumor; 1 (5.0%) had oral cancer (epidermoid carcinoma), and 1 (5.0%) had burning mouth syndrome (BMS) associated to fibromyalgia. Spontaneous descriptors of pain were not different between AFP and SFP groups (p=0.82). Allodynia was frequent in SFP (p=0.05) and emotion was the triggering factor most prevalent in AFP (p=0.06). AFP patients had more traumatic events previously to pain (p=0.001).


CONCLUSIONS
AFP patients had more: a) traumatic events previously to pain onset, and b) emotions as a triggering factor for pain. These data support the need of trained health professionals in multidisciplinary groups for the accurate diagnosis and treatment of these patients.
Nóbrega
José Cláudio Marinho
JC
Neurological Division, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, Brazil.
Siqueira
Silvia Regina Dowgan Tesseroli de
SR
Siqueira
José Tadeu Tesseroli de
JT
Teixeira
Manoel Jacobsen
MJ
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D002985:Clinical Protocols; D003937:Diagnosis, Differential; D005156:Facial Neuralgia / Q000175:diagnosis*; D005157:Facial Pain / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D009209:Myofascial Pain Syndromes / Q000175:diagnosis; D018710:Pain Clinics; D010147:Pain Measurement; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis*; D014276:Trigeminal Nerve / Q000503:physiopathology