Abstract
The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.
Highlights
Orofacial pain (OFP) has a prevalence of 10% to 15% in the adult population [1,2] is one of the most common causes of chronic pain after back, neck and knee pain [3,4]
To be able to judge the laterality of a picture it is believed that the subjects mentally needs to rotate an internal representation of their own body part examined to mentally match it with the presented one. This process, would be influenced by the motor and somatosensory areas, in terms of recognition of the position of the body parts in space and the visual stimuli [54]; when the laterality discrimination is in conflict, it may be associated with a distorted proprioception cortical scheme of the body [55]
In patients with somatoform disorders, it is suggested that the presence of a deficit of facial emotion recognition is a consequence of the concurrent alexithymia [107]
Summary
Orofacial pain (OFP) has a prevalence of 10% to 15% in the adult population [1,2] is one of the most common causes of chronic pain after back, neck and knee pain [3,4]. Pain [10] versus Migraine with Aura [7] are well described and easy to detect clinically within these definitions in contrast to chronic orofacial pain (COFP), whereby 60% of patients report having a form of headache [11]. This is supported by observational studies, which suggests clear comorbidity of chronic head-face-TMJ and neck pain [12]. Characteristics such as generalized mechanical hyperalgesia (head-faceneck and other body areas), alterations in pain modulation, increased expansion of pain areas and presence of associated psychological factors are in line with the process of central sensitization and are usually found in COFP patients [21,22]
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