Persistent Idiopathic Facial Pain Treatment & Management

  • Author: Stanley J Krolczyk, DO, RPh; Chief Editor: Robert A Egan, MD  more...
Updated: Oct 24, 2014

Approach Considerations

Medical treatment of persistent idiopathic facial pain (PIFP) is usually less satisfactory than medical treatment of other facial pain syndromes. Pharmacotherapeutic knowledge is paramount in the treatment of this refractory pain syndrome. A multimechanistic approach, using modulation of both ascending and descending pain pathways, is frequently necessary. The goal of therapy is to manage the pain effectively while giving rise to the fewest possible adverse medication effects.

Anticonvulsants (antiepileptic drugs [AEDs]) and antidepressants (eg, tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs], and norepinephrine reuptake inhibitors [NeRIs]) are the mainstays of pharmacologic treatment. Narcotics may be appropriate if administered under careful supervision.


Pharmacologic Therapy

Medications used to treat PIFP include the following:

  • Antidepressants
  • Anticonvulsants
  • Substance P depletion agents
  • Topical anesthetics
  • N -methyl-D-aspartate (NMDA) antagonists
  • Tetrahydrocannabinol (THC) or cannabidiol (CBD) receptor agonists
  • Opiate medications

Of these classes of medications, anticonvulsants and antidepressants appear to be the most effective.[21] The neuropathic component of the pain responds well to anticonvulsants and antidepressants.


Surgical, Psychiatric, and Alternative Treatments

Details of neurosurgical interventions to treat PIFP are beyond the scope of this review. If analgesic surgery is under consideration, it should be performed at a center well versed in such procedures. Occipital nerve block, though useful for treating several craniofacial neuralgias, does not appear to be especially effective against PIFP.[22, 23]

Psychiatric treatment is important in the overall management of a patient with chronic pain.

The results of a small study from Taiwan suggest that low-energy (eg, 800-nm wavelength) diode laser therapy may prove to be a useful alternative treatment for PIFP.[24]

Alternative therapies such as acupuncture and neuromuscular reeducation have been tried and should be considered as part of a comprehensive treatment plan. Available data on alternative treatments are limited.[25, 26]



Psychometric testing may be of benefit in the evaluation and treatment of patients with headache and facial pain. Many tests have been applied, but probably the most widely used is the Minnesota Multiple Personality Inventory (MMPI). Although psychometric testing is especially useful in the evaluation of the chronic headache and facial pain patients, a thorough discussion of such testing is beyond the scope of this discussion and is mentioned here only for completeness.

Consultation with a dentist may be of benefit.

All treatments should be provided in cooperation with the patient’s primary care physician.

Contributor Information and Disclosures

Stanley J Krolczyk, DO, RPh Associate Professor, Director of Multiple Sclerosis Center, Department of Neurology, University of South Florida College of Medicine

Stanley J Krolczyk, DO, RPh is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Osteopathic Association, American Headache Society

Disclosure: Received grant/research funds from TEVA for clinical trials; Received consulting fee from TEVA for speaking and teaching; Received consulting fee from EMD SERONO for speaking and teaching; Received consulting fee from BIOGEN for speaking and teaching; Received grant/research funds from EMD SERONO for clinical trials; Received consulting fee from Novartis for speaking and teaching; Received grant/research funds from NOVARTIS for clinical trials.


Martin A Myers, MD University of South Florida College of Medicine

Disclosure: Nothing to disclose.

Kavita Kalidas, MD Assistant Professor, Department of Neurology, University of South Florida College of Medicine

Kavita Kalidas, MD is a member of the following medical societies: American Academy of Neurology, American Medical Association, American Pain Society

Disclosure: Nothing to disclose.

Chief Editor

Robert A Egan, MD Director of Neuro-Ophthalmology and Stroke Service, St Helena Hospital

Robert A Egan, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, North American Neuro-Ophthalmology Society, Oregon Medical Association

Disclosure: Received honoraria from Biogen Idec for speaking and teaching; Received honoraria from Teva for speaking and teaching.


Joseph Carcione Jr, DO, MBA Consultant in Neurology and Medical Acupuncture, Medical Management and Organizational Consulting, Central Westchester Neuromuscular Care, PC; Medical Director, Oxford Health Plans

Joseph Carcione Jr, DO, MBA is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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