For many years, Atypical Facial Pain (AFP) represented a group of disorders that included most of the facial pain disorders that did not fit into the category of classic trigeminal neuralgia. As our understanding of the pathophysiology of the many facial pain disorders increased, a new classification for facial pain was developed that reflected this new knowledge. Thus, terms that were unnecessarily general were abandoned in favor of terminology that was more specific. Currently, AFP is reserved for facial pain of psychogenic origin.
Patients with AFP are thought to have psychological origins of their pain. Depression, unresolved conflicts, behavioral problems, or other psychological issues may result in AFP.
The symptoms of AFP can be quite variable. Patients may describe burning, aching, cramping, pinching, or pulling sensations. Commonly, symptoms exceed the confines of the trigeminal nerve distribution, or are bilateral in nature.
The diagnosis of AFP is made following a formal psychological evaluation, including a battery of psychometric tests. Additionally, other causes of facial pain, such as injuries to the trigeminal nerve or trigeminal neuralgia, must be excluded.
Since the pain from AFP is psychogenic in origin, psychological support, to include ongoing counseling if necessary, is the appropriate treatment. It is important for both patients as well as the treating physician(s) to realize that surgery is completely inappropriate for the treatment of this condition.
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