Three Types of Facial Pain

All pain in the human body is one of three types:
     Nociceptive Pain- Pain from tissue
     Neuropathic Pain- Pain caused from nerves not functioning properly
     Centrally Mediated Pain- Pain from the brain not functioning properly

Overtop of all three types of pain is how the brain interprets pain. This is affected by stress and emotion. This is not the source of the pain, but affects the pain experience.

Different Beliefs: Different Treatments
There is not a consensus among professionals on which types of pain are the most prevalent. I find in my patients that sore muscles and joints in the head and neck are the source of the majority of facial pain (Nociceptive Pain). I find it invaluable to examine the muscles and joints by palpation (push on) , find out what is sore, and then figure out why it is sore. Therapies are then based on removing the cause of the sore muscles and joints. I do have patients who do have neuropathic pain and centrally mediated pain, but these are not the majority.

You can tell a doctor’s beliefs on the main causes of facial pain by which therapies they administer the most. I treat the physical causes of pain with an occasional treatment for the other types. A doctor who believes neuropathic pain is the most prevalent, most likely will not palpate muscles and joints, but will write prescriptions for drugs like gabapentin, neurontin, and anti depressants. A doctor who believes most facial pain is caused by Psychosocial will recommend stress counseling, relaxation techniques, and anti-anxiety medication. They may recommend physical therapy for sore muscles, but believe the muscles are sore from emotional stress. While I agree that the brain’s interpretation of pain is a factor, I do not feel it is the cause of the pain. I have found if you remove the source of the pain, the pain goes away and most patients are no longer depressed.

I firmly believe the majority of headaches and facial pain is from sore muscles and joints. Palpating muscles and joints and identifying which ones are sore must be part of any examination for facial pain, including headaches. If your doctor does not thoroughly palpate the muscles and is quick to write you a prescription you may want a second opinion.

The Many Causes of Facial Pain, The Many Treatments

There are 190+ different causes of Temporomandibular Disorders/Facial Pain. The examination process, which needs to include muscle and joint palpation, will to lead to a working diagnosis on which you will be treated. A specific treatment is needed for each specific diagnosis. I utilize 70+ different therapies in my practice.