Atypical Facial Pain: A Survey of Treatment in the Manchester Area (UK)

Abstract

Introduction A review of the scientific literature found no unified opinion on the approach to the diagnosis and treatment of atypical facial pain (AFP). Aim To investigate the approaches to AFP, among the units of oral and maxillofacial surgery, oral medicine, anaesthetics, Ear, Nose and Throat (ENT), psychiatry and neurology in the Greater Manchester area (UK). Method Analysis of the clinical notes of 250 patients from a three-year period using a data collection sheet. Statistical analysis Chi-square and Kruskal-Wallis tests. Results AFP cases had a female preponderance and a long history of a persistent pain affecting no dominant location. Pain was of moderate to severe intensity, throbbing in quality and could disrupt sleep. Over half the cases had signs and symptoms related to other recognised types of facial pain. Effective treatments involved antidepressants and acupuncture. There was no unified pattern of referral between units. The short and long- term outcomes were influenced by treatment rather than the approach to diagnosis. Anaesthetic and neurology units had better outcomes than the oral and maxillofacial surgery and oral medicine units ( p<0.001). Conclusions Different specialities receive referrals diagnosed as AFP but there is no uniform approach to treatment and this results in different outcomes. A more uniform approach to care is required.