Persistent idiopathic facial pain (PIFP)

What is persistent idiopathic facial pain (PIFP)?

This is an unusual condition that is best regarded as a “diagnosis of exclusion”. This means that great care, attention and investigations have been undertaken to exclude any identifiable pathophysiological cause of the pain. It was previously referred to as atypical facial pain (AFP). The pain is undeniable however, and should satisfy the following diagnostic criteria:

• the pain occurs daily for >2 hours/day and has been ongoing for >3 months;
• the pain is both poorly localised (not following the distribution of a peripheral nerve) and of a dull, aching or nagging quality;
• the clinical neurological examination is normal;
• a dental cause has been excluded by appropriate investigations;
• the pain is not better accounted for by an alternative diagnosis.

What are the symptoms?

PIFP may manifest as dull, nagging, aching pain, with sharp exacerbations that are aggravated by stress. It may involve wider areas of the head and neck. It may be seen more often in patients with other chronic pain conditions (e.g. fibromyalgia) and/or patients with concomitant psychiatric co-morbidities. It is important to note that the interplay between these issues is complex, incompletely understood and requires careful and compassionate treatment, often using a multidisciplinary approach.

How is it managed?

I am acutely aware of the fact that a diagnosis of PIFP can be incredibly frustrating for patients. There has often been a long road to get to the diagnosis by the time patients have seen me, sometimes with multiple interventions and treatments along the way. Engendering acceptance of the very idea that a specific cause cannot be uncovered is paramount and at times a difficult idea for patients to make their peace with. I will spend a significant amount of time going through this slowly, providing reassurance and realistic treatment strategies for the future. This will often involve engaging the services of other specialists to ensure a “joined up thinking” approach to managing symptomatic control. This can include specialists from Pain Medicine and/or Psychology among others. I have spent time building these connections in the independent sector, to ensure you have a truly multidisciplinary approach to your care.