title: Interdisciplinary Management of Complex Regional Pain Syndrome of the Face.
abstract: OBJECTIVE
  Orofacial pain disorders are relatively uncommon and pose a substantial diagnostic challenge. This case report documents the diagnosis and management of hemifacial pain in a patient who was referred to an interdisciplinary pain medicine unit. The purpose of this case report is twofold. First, it presents complex regional pain syndrome (CRPS) as a potential differential diagnosis in cases of facial pain. Second, it describes the successful adaption of contemporary management approaches for distal-extremity CRPS to treat people with CRPS of the facial region.
  
  
  METHODS
  The patient had hemifacial pain and concomitant motor and autonomic symptoms after a small laceration of the eyelid. Extensive specialist medical evaluations were undertaken to exclude an underlying structural pathology. After detailed clinical assessments by a physical therapist, pain physician, and clinical psychologist, a diagnosis of CRPS involving the face was made.
  
  
  RESULTS
  The patient's pain was largely unresponsive to pharmacological agents. A modified graded motor imagery program, together with desensitization and discrimination training, was commenced by the physical therapist and clinical psychologist. A positive clinical response was indicated by a decrease in allodynia, normalization of motor control, and regained function in activities of daily living.
  
  
  CONCLUSIONS
  Complex regional pain syndrome is an infrequently reported differential diagnosis that can be considered in patients with persistent facial pain. This case report highlights how careful examination and clinical decision making led to the use of an innovative therapeutic strategy to manage a challenging condition.
authors.affiliation: L. Parkitny, PhD, MM(PainMgt), BPhysio, Neuroinflammation, Neuroinflammation, Pain & Fatigue Lab, Department of Psychology, The University of Alabama at Birmingham, 1300 University Blvd, Campbell Hall CH233, Birmingham, AL 35294 (USA). lukeparkitny@interleuk.in.
authors.forename: Luke
authors.initials: L
authors.lastname: Parkitny
authors.affiliation: B.M. Wand, PhD, School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia.
authors.forename: Benedict Martin
authors.initials: BM
authors.lastname: Wand
authors.affiliation: C. Graham, MAppPsych, Pain Medicine Unit, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: Carl
authors.initials: C
authors.lastname: Graham
authors.affiliation: J. Quintner, FFPMANZCA, Rheumatology and Pain Medicine, Arthritis and Osteoporosis WA, Shenton Park, Western Australia, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Quintner
authors.affiliation: G.L. Moseley, PhD, FACP, Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia; Pain Adelaide, Adelaide, South Australia, Australia; and Neuroscience Research Australia, Sydney, New South Wales, Australia.
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy / Q000209:etiology; D020918:Complex Regional Pain Syndromes / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005157:Facial Pain / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010348:Patient Care Team; D055815:Young Adult
chemical_list: D000700:Analgesics