Facial pain problems that occur as a result of nerve excitation present in ways that are quite distinguishable from pains that have muscle origins. In fact, the only similarity between nerve-related facial pain and muscle-related facial pain is that they are more common in women.
There are several types of nerve-related facial pain problems. Some can occur in isolated episodes, while others can be continuous. Continuous nerve pain may only have a moderate intensity, but due to the fact that it is always present, it is often more debilitating. The pain of continuous nerve pain problems is often accompanied by a sensation of burning, which adds to the level of suffering these problems, bring on. In contrast, episodic nerve pain is described with the words shooting, radiating, twitching and electric in character. A sufferer may have intense pain one moment and then seconds later absolutely no pain. This pattern of pain one second and none the next is what characterizes this type of problem. The most common type of episodic nerve pain is called trigeminal neuralgia or tic douleruex.
The origin of trigeminal neuralgia is most often unknown. Though about 20% of patients may have trigeminal neuralgia as a result of an identifiable disease, tumor or neurologic disorders, the vast majority develops this condition for no clear reason. Most individuals afflicted are older than 55 and women develop this condition more than men.
The pain of trigeminal neuralgia most often starts in the upper or lower teeth, which can lead to unnecessary dental treatment such as root canal. Over time, the facial pain occurs in the face, cheek, gums, and even the tongue. Normal stimulation like talking, eating, opening the mouth slightly, washing the face, shaving, or hair combing can be a trigger. Those with this problem often cover their face in the wind or cold weather. The diagnosis of this problem is more frequently based on the history provided, and not the result of an examination. Once diagnosed, patients can be treated with either medications or possibly surgery. In certain cases this condition can have periods of remission for weeks, months, or even years.
Continuous neuralgias can have a number of origins and are difficult to manage. Similar to trigeminal neuralgia, this facial pain can often emerge spontaneously in the teeth prompting dental treatment. These stubborn pains can also develop after fillings are placed; new caps cemented and even follow a tooth cleaning procedure. Once started they may linger despite no evidence of infection, or tooth compromise. If this scenario develops, patients often blame the dental procedure and look for a dental solution. Unfortunately, more dental treatment leads to more pain, and the vicious cycle continues.
The continuous nature of this facial pain can be debilitating, and presently, the only treatment available is the use of medications to dampen nerve discharge and build endorphins. Sadly, like all nerve problems, this condition can persist indefinitely.
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How I Diagnose Facial Pain
It has often been said that making an accurate diagnosis can only be achieved by taking a thorough history. For this reason, my relationship with patients begins with a conversation. Listening to what my patients have to say is my first priority. Subsequently a careful examination enables me to begin to narrow down the possible reasons for the pain and determine whether other tests or medical collaborations are needed.
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