Craniofacial Pain: Frequent Combined Diagnosis in Complex Unique Patients

Silvia Regina Dowgan Tesseroli de Siqueira

doi:10.37871/jbres1574

ISSN: 2766-2276

Medicine Group . 2022 October 14;3(10):1180-1181. doi: 10.37871/jbres1574.

Subject area(s)

Pain and Relief

| | |

Opinion

Craniofacial Pain: Frequent Combined Diagnosis in Complex Unique Patients

Silvia Regina Dowgan Tesseroli de Siqueira*

Department of Neurology, University of Sao Paulo, Brazil

*Corresponding author: Silvia Regina Dowgan Tesseroli de Siqueira, Department of Neurology, University of Sao Paulo, Brazil E-mail:

Received: 23 September 2022 | Accepted: 13 October 2022 | Published: 14 October 2022

How to cite this article: de Siqueira SRDT. Craniofacial Pain: Frequent Combined Diagnosis in Complex Unique Patients. 2022 Oct 14; 3(10): 1180-1181. doi: 10.37871/jbres1574, Article ID: jbres1574

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Pain is a frequent symptom that is present in several areas of the medical field. Innumerous conditions show this unpleasant complaint, which pathophysiological particularities need to be understood in order to achieve an accurate diagnosis. Besides, although there are diagnostic criteria and classifications essential to the clinical practice, there is a role of individual parameters, such as previous pain experiences, personality, pain history, comorbidities, predisposing factors, and associated diseases [1,2]. This unique combination of factors makes pain a singular experience, a reason why patients’ assessment by doctors depends on training, study, and dedication.

In craniofacial pain practice, hundreds of diagnoses are possible and may be combined; some of the most challenging conditions depend on the exclusion of all others [3]; and the complexity of the trigeminal system includes enormous convergence of sensory information, increasing the prevalence of referral pain [4]. Therefore, it is not rare to find an intricate clinical scenario guided by a subjective symptom.

Our recent results have shown that functional and somatoform symptoms are often associated with craniofacial pain (63.8% of patients) [2]. These symptoms include conditions that show no findings in complementary exams and have no identifiable organic cause [5,6]. They were more frequent in patients having Temporomandibular Disorders (TMD), fibromyalgia, and other non-neuropathic conditions [7,8], which can correspond to multimorbid states that often include gastrointestinal abnormalities and psychiatric disorders associated [9,10]. Neuropathic facial pain, on the other side, was mostly associated with non-functional diseases, and its diagnostic criteria include sensory abnormalities that can be found in the clinical examination of the patient, as well as pain distribution in the territory of a nerve or nerve branch [8].

The identification of comorbidities and other local or systemic previous diseases should be always included in the anamnesis of the patient. Craniofacial pain can be a symptom of one of these conditions, or it can be aggravated/modulated by that. Several illnesses may have overlapping mechanisms involving inflammatory, immunologic and neurological factors, which can underlie the associations observed in patients. In several situations, patients’ referral to other colleagues from other medical specialties will be necessary; it is known that chronic pain assessment depends on a multidisciplinary approach. Knowing the conditions that overlap with the one that is been examined, even if they are from other specialty, will help in the identification and more accurate referral to the right professional, and the evaluation will be even more effective if all members of the health team have been trained about pain.

Other aspect that should be in mind when evaluating a patient is that pain is experienced as suffering, and it results in behaviors and emotional symptoms that are modulated by personal traits as the personality and the individual strategies of coping [11]. It has been observed a high index of harm avoidance, pessimism, and low levels of cooperation and self-transcendence in patients with pain, which needs further research. This should be considered when planning the strategy of assessment to achieve higher levels of adherence of the patient to the treatment [12]. Besides, there is an impact of pain in life that affects the existential dimension [1], and the support of trained psychologists can contribute to the success of the treatment of patients with craniofacial pain [13].

During the last decades, several progresses in craniofacial pain area have been witnessed, and the comprehension of overlapping among associated factors has increased. There are many advances in treatment, however it is never enough to remember that a good therapeutic needs to be in accordance to diagnostic, and iatrogeny is still an issue to be avoided. Besides, patients are suffering and they deserve an approach that helps them to cope with, which respects their personal and individual characteristics, and avoids delays in the process of diagnosis and referrals, when this is necessary. Thus, training doctors and improving the understanding of basic and clinical sciences, never losing the larger picture of pain as a phenomenon in a whole person, is a path for better assessment and therapeutic effects in the future.