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Atypical face pain / chronic facial pain

This term is used to describe facial pain for which no cause can be found and which does not respond to the usual painkillers. The pain can be intermittent or continuous, of varying intensity and can last for years. It may affect a small area of the face, but it can also spread across the whole of the face and mouth. The pain is described as nagging, throbbing and aching.

It is often associated with pains in other parts of the body, such as irritable bowel syndrome and itchy skin. As a consequence of the pain, many people with this condition are affected by anxiety and depression. The condition has been linked to stress and life changes such as moving house, changing jobs or divorce.

There are no tests to aid in the diagnosis of this condition, so doctors are very reliant on an accurate description of the symptoms.

Atypical odontalgia

Odontalgia is a medical word for toothache. Atypical odontalgia is a severe and continuous discomfort in the teeth or a tooth socket that is not caused by any apparent dental problems. Oddly the pain may be made worse if dental treatment is pursued, though it is very common for teeth to have been removed by the time the diagnosis becomes clear. The pain often begins after a tooth has been taken out or following a root filling.

Burning mouth syndrome - Oral dysaesthesia

This is a group of problems that include a burning or altered sensation in the tongue or other parts of the mouth. It may be associated with a nasty taste or sense of too much or too little saliva. There may also be a feeling of numbness. Dentures, crowns and bridges may become uncomfortable to such a degree that it is impossible to wear them despite all attempts to modify the shape. It mainly affects women who have been through the menopause.

How are these conditions diagnosed?

There is no specific test that will prove the existence of any of these conditions. A dental or medical specialist will make a very careful examination of the mouth and the other affected areas to rule out causes such as thrush. Often investigations such as x-rays, scans and blood tests will be carried out to rule out other conditions such as diabetes, anaemia and vitamin deficiencies. Once the diagnosis has been confirmed and other problems excluded, treatment may begin.

What causes the pain?

These conditions are not yet fully understood. Some cases of burning mouth syndrome may be related to an oral thrush infection, vitamin deficiency or rarely an allergy to dental materials, but in many cases the actual cause or trigger is unknown. However, it is believed that the pain itself may result from cramped muscles and dilated blood vessels which lead to the production of chemicals in the blood, causing pain, anxiety and even depression. These conditions tend to be made worse by tiredness and stress.

What treatments are available for atypical face pain, atypical odontalgia and burning mouth syndrome?

Simply to have an accurate diagnosis and some understanding of the condition leaves many people much better able to cope with their pain. Treatment is based on drugs, often supported by "pain management techniques" (see below). There is no surgical solution to these problems. Your specialist will advise you on what is best in your particular case.

What drugs are used?

The most frequently prescribed drugs are antidepressants. These are not prescribed because it is felt that you are necessarily depressed, but because these drugs are now known to have a specific effect on certain forms of chronic pain. If the pain has made you depressed then they will of course help that problem too. The most commonly used medicines are amitriptyline, nortriptyline and fluoxetine (Prozac). These drugs will often need to be taken for several months before they become fully effective, and they may need to be taken for a year if they are to be of lasting benefit.

These are safe drugs that very seldom have serious side effects, though many people taking amitriptyline and nortriptyline complain of mild drowsiness and/or a dry mouth, and some people become constipated while taking them. The effects of drowsiness and constipation tend to be worse for elderly people. Amitriptyline and nortriptyline are best avoided if you suffer from certain conditions such as glaucoma, or prostate problems. Your doctor will take all these things into account before prescribing them to you, and will be able to discuss any concerns. Other related drugs may be used if you experience side effects.

What are pain management techniques?

Pain can feel worse if you feel it has become out of control and if you become stressed. Pain management techniques aim to teach you methods of coping better with the pain when it breaks through the treatments. They also aim to help you to control stress better and thus prevent it from making the pain worse. These methods are often taught by psychologists. A referral to a clinical psychologist should not be taken as meaning that the doctor believes your pain is due to a mental problem. People with chronic pain of any kind can gain benefit from this sort of treatment.

The treatment sessions will usually consist of teaching you relaxation techniques and coping strategies for when the pain is severe. These may include cognitive behaviour therapy, which is a technique that helps you to think positively about your pain and how to cope with it. You may need to attend on several occasions, and the idea is for you to learn the methods so that you can use them on your own.

The use of these techniques varies very much from one hospital or specialist unit to another, but they are becoming increasingly popular and you can discuss them with your doctor.



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