Maxfacts

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Facial pain syndrome

 Idiopathic / atypical facial pain

Time-lines short term: This may be best thought of as gaining relief, possibly only to a degree of the most acute aspect of pain. This may be by injection or oral medication and will act within minutes and last hours.

Time-lines medium term: This is a process of coming to terms with a condition which may not have a definitive cure and will probably require both long term medication or therapy and a completely different perspective on the situation. This takes several months.

Time-lines long term: Now you come to terms with your condition accepting that while it may be lifelong there will be good times and bad times. A balance between a selfhelp approach and a professionally directed approach will allow you to continue to function and get the most from life. This may take years to fully adapt to.

Trigeminal neuralgia

Time-lines short term: Relief within hours of trying the antiepileptic medication carbamazepine (which up to 80 % of people will gain) can be life changing and affirming. Minutes to hours.

Time-lines medium term: Realising that you may be on lifelong medication takes some adapting to, as does the realisation that breakthrough pain can occur unpredictably. This takes place over a period of months.

Time-lines long term: This can range from fully adjusting to lifelong medication to coming to terms with the consequences of perhaps invasive neurosurgical treatment – for example trading being pain free with long term loss of sensation.

Odontalgia / atypical odontalgia

Time-lines short term: This may be best thought of as gaining relief, possibly only to a degree of the most acute aspect of your pain. This may be by injection or dental intervention and will act within minutes and last hours.

Time-lines medium term: This is a process of coming to terms with a condition which may not have a definitive cure and will probably require both long term medication or therapy and a completely different perspective on your situation. This takes several months and may be very frustrating. Do not be tempted to push for the removal of multiple healthy teeth.

Time-lines long term: Now you come to terms with your condition accepting that while it may be lifelong there will be good times and bad times. A balance between a selfhelp approach and a professionally directed approach will allow you to continue to function and get the most from life. This may take years to fully adapt to.

Pulpitis

Time-lines short term: Analgesia may help but definitive dental treatment is needed. Minutes to hours.

Time-lines medium term: Removal of or direct treatment of an inflamed pulp by direct dental means should be definitive.

Time-lines long term: There should be none.

Periapical periodontitis and abscess

Time-lines short term: Analgesia may help but definitive dental treatment is needed. Minutes to hours.

Time-lines medium term: Removal of or direct treatment of an inflamed pulp by direct dental means should be definitive.

Time-lines long term: This is largely the psychological impact of tooth loss and prosthetic replacement.

Glossodynia and sore mouth (also known as ‘burning mouth syndrome’ or ‘oral dysaesthesia’)

Time-lines short term: This may be best thought of as gaining relief, possibly only to a degree of the most acute aspect of your pain. This may be by injection or oral medication and will act within minutes and last hours.

Time-lines medium term: Overall treatment for this condition is very problematic and expectations will have to be realistic. Gaining this perspective is essential to maintaining a useful quality of life.

Time-lines long term: Now you come to terms with your condition accepting that while it may be lifelong there will be good times and bad times. A balance between a selfhelp approach and a professionally directed approach will allow you to continue to function and get the most from life. This may take years to fully adapt to. Anything that helps and does no harm is worth considering. Beware the risks of dependence on long-term analgesia, particularly those containing mood-altering constituents such as opioids or some anticonvulsant medications such as gabapentin.

Cracked tooth syndrome

Time-lines short term: Analgesia may help but definitive dental treatment is needed. Minutes to hours

Time-lines medium term: Definitive restoration by dental means should be all that is needed.

Time-lines long term: None.

Trigeminal herpes zoster

Time-lines short term: High-dose analgesia in conjunction with anti-viral treatment is essential and usually effective. Response within a few days.

Time-lines medium term: Itching and sensitivity settle over a few weeks unless postherpetic neuralgia (see below) becomes an issue.

Time-lines long term: None unless postherpetic neuralgia evolves.

Postherpetic neuralgia

Time-lines short term: This painful condition is best prevented as above. If not, the most acute pain responds to opioid analgesia.

Time-lines medium term: If persisting, neuropathic analgesia will be helpful but may be required lifelong. A balanced and realistic expectation of pain management becomes essential.

Time-lines long term: Long-term avoidance of exacerbating factors and lifestyle modification with lifelong neuropathic analgesia may be needed.

Secondary neuralgia from central nervous system lesions

Time-lines short term: Neuropathic analgesics usually help short term, days to weeks.

Time-lines medium term: Entirely dependent on the central nervous system lesion

Time-lines long term: See above.

Glossopharyngeal neuralgia

Time-lines short term: Relief within hours of trying the antiepileptic medication carbamazepine (which up to 50 % of people will gain) can be life changing and affirming. Minutes to hours. Not as immediate as with conventional trigeminal neuralgia (see above).

Time-lines medium term: Realising that you may be on lifelong medication takes some adapting to, as does the realisation that breakthrough pain can occur unpredictably. This takes place over a period of months.

Time-lines long term: This can range from fully adjusting to lifelong medication to coming to terms with the consequences of perhaps invasive neurosurgical treatment – for example trading being pain free with long term loss of sensation. Be aware that although glossopharyngeal neuralgia has similarities to trigeminal neuralgia (see above), it is not as clear cut a process nor as responsive to medication.