Ive been reading about AFP and it seems the general consensus amongst the medical community is that its considered merely a psychological issue? Seems a little obnoxious and dismissive to me. Anyone with any input?
BTW I read this definition on Columbia/Presbyterian Neurosurgeons webpage
Unbelievable
Iāve had ATN for close to 15 years and itās never so much as been implied that itās psychological in nature to me. I also have not come across that as a āgeneral consensusā in all of my research over the years.
I tried to find the info youāre referring to by searching Columbia/Presbyterian Neurosurgeons and couldnāt find anything. Do you have a link?
I pasted the link about Atypical Facial Pain as a Psychological issue from their website
I think itās easier to dismiss ATN/AFP as more of a psychological issue requiring mood enhancing or stress relieving drugs ā¦ if you have never experienced the pain!!
Iāve received a more compassionate response from medical professionals who have themselves experienced debilitating pain ā¦
ā¦ from others Iāve been advised that my earache or headache is really my bodyās response to the need for pain medication by providing imaginary pain to get the āfixā the drugs supply ā¦ and that if I get the best psychological counselling to sort out my stress and anxiety I should have no more pain, real or imagined.
It makes me sooo mad ā¦ if only I could get them to spend 24 hours in my skin, they could appreciate that :
Firstly ā¦ the pain is NOT imaginary or as a result of an addiction to pain relief medication
Secondly ā¦ itās so debilitating that I simply cannot function on any level during an attackā¦ all my energy and effort is consumed in getting through the next 15 or 20 minutes that it takes for the medication to provide relief
Thirdly ā¦ no amount or neurological or psychological drugs will ease pain caused by vascular compression of cranial nerves.
I so agree with you. I know 100% my affliction began with lifelong TMJ issues i didnāt realize i had and TN that was spurred on by dental injections hitting my nerve several times ( injections shocked my cheek tongue and lip several times left interior alveolar nerve ) from all my tooth extractions and root canals that were all unnecessary in hindsight. This is so not flipping psychological. Im disgusted that a reputable institution such as Columbia would put it out there in any shape or form that any pain especially AFP is psychological only. ANY Dr who dares say this to me is going to immediately see my backside out their door with no hesitation.
That article sounds like theyāre parsing down the general category into more specific categories that deal more directly with causation rather than lumping it all into āfacial pain.ā The article even specifically notes that other causes of facial pain, such as injuries to the trigeminal nerve or trigeminal neuralgia, must be excluded. Iām actually good with this entire line of inquiry.
In fact, there was a member here several years ago who fits this paper perfectly for having psychological origins of their pain. Depression, unresolved conflicts, behavioral problems, or other psychological issuesā¦ those could all be applied to the person Iām recalling!
Depression does amazing things to your body and I do think that needs to be considered when dealing with rare disease states. The trick is, it canāt be the default setting for Dx!
My concern from what i understand, and im new to this so theres a wide line of learning for me on facial pain issues, my fear is that by assigning psychological problems for people with atypical facial pain could be misleading and could spark other professionals to take that article and use it as a weapon of dismissiveness for people who really are having atypical facial pain that are/ were not psychologically unhealthy? From what i understand, and i may be wrong, not all TN is discovered via imaging modality and atypical facial pain could be related to a TN problem just not obvious like some people who have positive MRIs etcā¦
I guess what im asking, if one is diagnosed with Atypical Facial Pain is it only because they are depressed? That is the only factor? Is that the consensus. Thanks for your input. 
Iāve never ever heard ATN described as psychological and I doubt many neurologists would think so either. If this article does indeed claim this (I havenāt looked at it yet) then they are in a minority of one, as far as my reading/research goes. I donāt think you need have any fears whatsoever of doctors being influenced by it; youād be lucky if any doctors read it!
Just had a look at it and I see they are speaking specifically about atypical facial pain, not the neuralgias. They are also clear that it is only pain which has no physical origin, plus they say the patient must have a battery of psychological tests before being diagnosed with AFP, so they are talking about a very specific class of patient. Just about any part of the body can suffer psychosomatic pain and the face is not only no exception but has things such as tooth grinding, tension in the neck, migraine headaches, sinus issues, all of which might trigger facial pain. Anyone stressed or depressed is more likely to suffer these things so I donāt think it is unreasonable to suggest there might be a psychological reason behind AFP.
However, I can see why you might be worried about this, but as Iāve said, youād be lucky any doctor would read this. In my experience they donāt even know what classic TN is never mind rarer variations! And theyāre not big on research either. If you have some physical history to your ailment, like dental damage, then you neednāt worry about it being treated as psychological - you have proof!
E.T.A. I would just add that I share your misgivings about doctors armed with the āitās all in your headā argument but I believe that is entirely their own fault as something being āin your headā doesnāt make it any less dangerous or destructive to your body. If they could learn that weād all be better off.
Thanks so much for all your help everyone. Its all so confusing if something is or is not psychological for people that may have clean diagnostic imagings. Im still learning about this disorder. I guess i just hate to see any word psychological as a dominant diagnoses.
I modified my post to reflect that my inguiry is for AFP only. I apologize for lumping ATN into this question. Thx
Yes atypical trigeminal neuralgia or TN2 is different from atypical facial pain. I have both TN1 and TN2 and it took me a while to understand the terminology. Emgeorge would mind if I asked why there saying it is atypical facial pain? Have you had a second opinion from a neurologist? The medications that treat TN are pretty different, usually anticonvulsants where atypical facial pain does seem to show some results from some antidepressants. (Although there are some that help TN also)
I donāt blame you for being upset at the idea that it is psychological. Itās hard enough as a chronic pain patient. And not to go even further into the issue but I have bipolar as well which is caused by genetics and trauma. Trauma actually changes the brain. So, this whole āpsychologicalā issue miffs me in many ways.
But back on track, yes I just wanted to make sure youāve had the diagnostic testing and second opinion and by neurologists.
Whatever your actual diagnosis, I hope you can find something that helps. 
Hi Galimatias thanks for replying.
I havenāt been diagnosed with AFP. I was told I have some sort of TN disorder most likely from numerous dental work that seem to have caused nerve issues in my left jaw. This coupled with TMJ that is really out of control due to improper bite since i have no remaining molars. This includes premolars. It eluded me for years that all my āfailedā root canal work was most likely due to worsening TMJ/TN issues. No dentist / oral surgeon thought about this possibility when i would ask or extractions to try to eliminate pain. Everything is spiraling downwards faster these days. I use to have painfree days now i dont. On top of electric shock teeth pain, i can now add Severe earaches, headaches, stabbing eye pain. all have now entered my daily life now. Im not under a neuro dr care now but i am to see a TMJ dr to evaluate me and maybe give me a plan. I know it will involve getting dentures to stabilize my mouth but insurance will not cover until next year. So im doing the best i can for now. I just cant believe this is my life now. Crazy sad fate.
Iāve working in the health/prescription insurance industry for more than 25 years. With that in mind, I have suggestions for you EmGeorge:
Talk to medical. Your situation may go beyond ādentalā and cross the line into major medical, particularly with a Dx of TN or ATN. And, if any of your mouth problems were ever cause by an event (line drive to the face, car accident, tree limb to the head) it may also be covered by medical rather than dental or a combination of the two. You might even qualify for assistance in paying for implants since a lack of teeth is throwing off your bite causing jaw problems. You need to find an afternoon with several hours free and get on the phone with your medical insurance.
Look at how your dental insurance is structured. Most reset in January so a good way to schedule major work is part billed in December, part billed in January. This will allow you to get the most done possible in the shortest amount of time and make maximum use of your dental coverage. Since you know youāre looking at major dental work when you renew your plan in Oct/Nov renew for the max you can, you want the best coverage with the best options for 2019. Thereās no way you wouldnāt come out ahead of the game and then you can reduce your coverage the following year. Actually, come to think of it, do that with medical too. Research your medical plan for any qualifying dental issues and sign up for the plan that covers that for one year (assuming you have options via your employer).
Look around into getting secondary dental insurance you pay for yourself. Again, with the amount of dental work youāre probably looking at for 2019 I donāt see how you wonāt come out ahead in the long run.
Get a comprehensive treatment plan from at least two different dentists. Donāt tell them much about your history, let them go in cold and figure it out. Compare the plans and make decisions from there, including insurance you purchase. Donāt let them talk to you about ācosmeticā stuff, either, you want functionality only at this point. Functionality has a better chance of being picked up by medical, assuming you can link your issues to a medical event or Dx and not just dental.
Itās going to be annoying. Itās going to be frustrating. Take good notes and never lose your cool with the member services person trying to figure out what youāre talking about, it you get a very bad rep who 's not listening or talking over you donāt get upset, just end the call and call back to talk to someone else. You have a complicate issues on your hands and youāre going to be talking about non-standard coverage, which is confusing for everyone.
Feel free to PM with more questions about insurance, Iām happy to help. And do keep us posted in general!
Historically speaking, it was believed to be psychological. That is an outdated believe. It is no longer accepted as that. If any professional suggests that then find a new DR.
Wow thank you so much for all that incredible information you have shared. Never thought that dental could in anyway be under medical. That makes sense when you put it as a jaw illness necessity. My insurance is the pits. Dental gives me only $2000 annual. Im tapped out already as you can imagine. When i see a tmj dr ill also question dental work under medicalā¦ Thanks again!
Itās not in your head but literally it is in your head. I got that for 25 years. Finally a neurosurgeon decided to do MVD found 4 areas of the petrosal veincompressing the trigeminal nerve. Itās not in your head keep persisting in getting someone to listen.
My Best
Joanne Tatto20
Hello
Have you found relief for tn2 with the MVD? Iām considering it as gamma knife failed. Canāt take meds. I have both tn1 and tn2.
Thanks!
Camia
Hi Camia
It is personal preference under advisement of your neurosurgeon. I am not sorry I had the MVD and had gamma knife in the last 8 months for reoccurrence of my symptoms. Iām not going to lie the surgery did relieve a lot of my symptoms for a short time. Itās different with a vein or an artery. Most times they have to go in a second time for veins. I guess itās the nature of the @ Beastā. I would have MVD again no regrets. Folks that do not know how debilitating TN is along with the pain!! Dont be afraid your decision will fit you not m or anyone else.
My Best
Tatto20 Joanne