What is Facial Pain Syndrome?

Just curious if anyone has ever seen this on one of their doctor's notes or medical charts? I was reviewing my paperwork from the first visit with my diagnosing Neurologist. During my visit that day, the neurologist verbally said to me that I appeared to have pain on 3 out of 5 points of my face that he claimed were trigger areas that were nerve endings on the right side for the 5th cranial nerve. He specifically mentioned my Ophthalmic nerve on the right side as one that was most agitated when he did a sort of pressure test comparison between the left and right side of my face. He did this by pushing his thumbs into points on my face symmetrically and checking for muscular and verbal reactions from this test. He told me that I appeared to be extremely light sensitive on the right side, have neuralgia of the 5th cranial nerve, and have a permanent headache based on my description. He specifically mentioned that he thought I have a variety of Trigeminal Neuralgia the a chronic Indocin responsive headache.

This morning, I pulled out the copy of my records that they voluntarily sent me from my visit that day. It includes a copy of a note that they mailed to my General Physician who had referred me. In that letter, the neurology resident that was present that day for the exam (the one that typed up the letter even though the head neurologist examined me primarily) said to my GP that I have: "...what may be two primary problems.One is Migraine headaches with the constant daily headache, photophobia and phonophobia. Second patient does have some sort of a neuropathic pain in the CN V such as trigeminal neuralgia or some other syndrome that is irritating the CN V." At the very end of the letter, after discussing the medication treatment they prescribed, he notes. "1) Facial Pain Syndrome (351.8BJ) 2) Migraine (346.90A)"

I understand through my own brief research today that those last two are billing codes for insurance. That stated, I am getting mixed results from Google as to what Facial Pain Syndrome is. It concerns me that the head neurologist that examined me told me, that I had Trigeminal Neuralgia with a chronic headache. He even mentioned that there are two types of TN and I likely have the second variety. Yet, the letter to my GP and to the billing to my insurance says Facial Pain Syndrome and Migraine. Some sites refer to "Facial Pain Syndrome" as a psychosomatic idiopathic pain disorder of the face. Others say it is a host of facial nerve disorders including TN.

Am I being a worry wort about this or should I ask my neurologist to clarify when next I see him later this month?

Fred

The term "facial pain syndrome" is a garbage diagnosis equivalent to "be damned if I know". It is not a recognized medical entity. Some practitioners improperly equate it to "complex somatiform pain syndrome" which is a psychsomatic disorder from the Diagnostic and Statistical Manual of the American Psychiatric Association. This latter designation is being challenged in the editing and consensus process for the DSM-V, given that there is no body of validated observational data, and no proven course of treatment for the "disorder".

Be advised that the Medical Advisory Board of the TN Association recently published a note on their site that they have decided to re-classify the term "Atypical Facial Pain Syndrome" as "trigeminal pain of obscure origin".

Feel free to come back and talk.

Regards,

R.A. "Red" Lawhern, Ph.D.

Resident Research Analyst

Red,

Should I ask my Neurologist to clarify this on my records, or am I worrying too much about this? Since he said Trigeminal Neuralgia in the note to my General Physician, is that "Facial Pain Syndrome (351.8BJ)" just for billing purposes? What are your thoughts?

Ask the doctor. He may not be the last physician you work with, and the last thing you want floating around in your records is anything that a small mind might interpret as evidence of psychosomatic illness.

Regards