|
Atypical Facial Pain (AFP, also termed atypical facial neuralgia,〔 chronic idiopathic facial pain, or psychogenic facial pain), is a type of chronic facial pain which does not fulfill any other diagnosis.〔 There is no consensus as to a globally accepted definition, and there is even controversy as to whether the term should be continued to be used. Both the International Headache Society (IHS) and the International Association for the Study of Pain (IASP) have adopted the term persistent idiopathic facial pain (PIFP) to replace AFP. In the 2nd Edition of the International Classification of Headache Disorders (ICHD-2), PIFP is defined as "persistent facial pain that does not have the characteristics of the cranial neuralgias () and is not attributed to another disorder."〔 However, the term AFP continues to be used by the World Health Organization's 10th revision of the International Statistical Classification of Diseases and Related Health Problems and remains in general use by clinicians to refer to chronic facial pain that does not meet any diagnostic criteria and does not respond to most treatments.〔 The main features of AFP are: no objective signs, negative results with all investigations/ tests, no obvious explanation for the cause of the pain, and a poor response to attempted treatments.〔 AFP has been described variably as a medically unexplained symptom, a diagnosis of exclusion, a psychogenic cause of pain (e.g. a manifestation of somatoform disorder), and as a neuropathy. AFP is usually burning and continuous in nature, and may last for many years. Depression and anxiety are often associated with AFP, which are either described as a contributing cause of the pain, or the emotional consequences of suffering with unrelieved, chronic pain. For unknown reasons, AFP is significantly more common in middle aged or elderly people, and in females. Atypical odontalgia (AO, also termed phantom tooth pain,〔 psychogenic toothache, or persistent dentoalveolar pain disorder),〔 is very similar in many respects to AFP, with some sources treating them as the same entity, and others describing the former as a sub-type of AFP. Generally, the term AO may be used where the pain is confined to the teeth or gums, and AFP when the pain involves other parts of the face.〔 As with AFP, there is a similar lack of standardization of terms and no consensus regarding a globally accepted definition surrounding AO. Generally definitions of AO state that it is pain with no demonstrable cause which is perceived to be coming from a tooth or multiple teeth, and is not relieved by standard treatments to alleviate dental pain. Depending upon the exact presentation of atypical facial pain and atypical odontalgia, it could be considered as craniofacial pain or orofacial pain. It has been suggested that, in truth, AFP and AO are umbrella terms for a heterogenous group of misdiagnosed or not yet fully understood conditions, and they are unlikely to each represent a single, discrete condition.〔 ==Classification== AFP has also been described as a medically unexplained symptom,〔 which are thought by some to be largely psychogenic in nature.〔 However, true psychogenic pain is considered to be rare.〔 Some sources have assigned or categorized AFP as a psychosomatic manifestation of somatoform disorder, as defined in the Diagnostic and Statistical Manual of the American Psychiatric Association. Distinction should be made between somatoform disorder, where affected individuals are not inventing the symptom for some benefit, and other conditions like factitious disorder or malingering.〔 Recent evidence in chronic facial pain research appear to suggest that a proportion of individuals who have been diagnosed with AFP have neuropathic pain,〔 AFP is described as one of the 4 recognizable symptom complexes of chronic facial pain, along with burning mouth syndrome, temporomandibular joint dysfunction (TMD) and atypical odontalgia. However, there is a degree of overlap between the features of these diagnoses, e.g. between AFP and TMD and burning mouth syndrome. Atypical odontalgia is similar in nature to AFP, but the latter term generally is used where the pain is confined to the teeth or gums, and AFP when the pain involves other parts of the face.〔 Other sources use atypical odontalgia and AFP as synonyms,〔 or describe atypical odontalgia as a sub-type, variant,〔 or intra-oral equivalent of AFP. Sometimes "phantom tooth pain" is listed as a synonym for AO, and sometimes it is defined as toothache which persists after a tooth has been extracted.〔 It has been suggested that it is likely that these terms do not represent a single, discrete condition,〔 but rather a collection of misdiagnosed and as yet unidentified causes. This pain is often similar to pain from organic dental disease such as periapical periodontitis, or pulpitis (toothache),〔 but unlike normal dental pain, it is not relieved in the long term by dental treatments such as endodontic therapy (root canal treatment) or tooth extraction, and it may even be worsened,〔 return soon after, or simply migrate to other areas in the mouth following dental treatment. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「atypical facial pain」の詳細全文を読む スポンサード リンク
|