Persistent Idiopathic Facial Pain Treatment & Management

  • Author: Stanley J Krolczyk, DO, RPh; Chief Editor: Robert A Egan, MD   more...
 
Updated: Mar 1, 2012
 

Medical Care

Medical treatment of PIFP is usually less satisfactory than medical treatment for other facial pain syndromes.

Medications used to treat PIFP include antidepressants, anticonvulsants, substance P depletion agents, topical anesthetics, N -methyl-D-aspartate (NMDA) antagonists, THC/CBD receptor agonists, and opiate medications. Of these classes of medications, anticonvulsants and antidepressants appear to be the most effective. The neuropathic component of pain responds well to anticonvulsants and antidepressants.

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 with the fewest adverse medication effects.

Anticonvulsants and antidepressants are the mainstays of medication treatment. Narcotics may be appropriate if administered under careful supervision.

Alternative therapies such as acupuncture and neuromuscular reeducation have been tried and should be considered as part of a comprehensive treatment plan.

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

Available data on alternative treatments are limited.[18, 19]

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Surgical Care

Details of neurosurgical interventions are beyond the scope of this review. Analgesic surgery should be considered at a center well versed in these procedures.

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Consultations

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). While especially useful in the evaluation of the chronic headache and facial pain patients, a thorough discussion of psychometric 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.

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Contributor Information and Disclosures
Author

Stanley J Krolczyk, DO, RPh  Assistant 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 Headache Society, American Medical Association, and American Osteopathic Association

Disclosure: TEVA Grant/research funds CLINICAL TRIALS; TEVA Consulting fee Speaking and teaching; EMD SERONO Consulting fee Speaking and teaching; BIOGEN Consulting fee Speaking and teaching; EMD SERONO Grant/research funds CLINICAL TRIALS; Novartis Consulting fee Speaking and teaching; NOVARTIS CLINICAL TRIALS

Coauthor(s)

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

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

Disclosure: Nothing to disclose.

Martin A Myers  University of South Florida College of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Robert A Egan, MD  Director of Neuro-Ophthalmology, 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, and Oregon Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Robert A Egan, MD  Director of Neuro-Ophthalmology, 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, and Oregon Medical Association

Disclosure: Nothing to disclose.

References

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