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Types/Classification

     
 
 

A New Classification for Facial Pain

A patient-oriented classification scheme for facial pains

Please note: 

Your doctor or other healthcare professional may not know about or use this classification system.  Use it to help you describe your pain.


Anatomy

The trigeminal nerve innervates a portion of the scalp, the face, nose, inside the nose, lips, inside the mouth, part of the tongue, and every tooth in the mouth.  However, because the trigeminal nerve is involved does not establish the diagnosis as being TN. 

Problem

Often it proves difficult for the physician and patient to determine the fine differences between classic trigeminal neuralgia and trauma induced trigeminal neuropathic pain.  In order to decide on the proper treatment plan it is imperative to recognize these differences.  A destructive procedure used for classic TN could make neuropathic pain much worse.

 

Clarification

In an attempt to distinguish these differences, Dr. Kim Burchiel, Department of Neurological Surgery, Oregon Health & Science University and a member of TNA’s Medical Advisory Board, has developed a patient-oriented classification scheme for facial pains commonly encountered in neurosurgical practice. He notes that this classification is driven principally by the patient's history.

A new classification for facial pain

Previously, anything other than classic TN used to be lumped into the broad heading of “atypical.”  To be consistent, TNA uses Dr. Burchiel’s classification system, described in Striking Back! The Trigeminal Neuralgia and Face Pain Handbook, which was published by TNA in late 2004.  Please be aware that there is not one universally accepted classification for TN and related facial pain conditions.  Therefore, your doctor may not identify pain using these same terms. 

Following are the seven types of face pains that Dr. Burchiel proposes:

  • Trigeminal neuralgia, type 1, (TN1): facial pain of spontaneous onset with greater than 50% limited to the duration of an episode of pain (temporary pain).
  • Trigeminal neuralgia, type 2, (TN2): facial pain of spontaneous onset with greater than 50% as a constant pain.
  • Trigeminal neuropathic pain, (TNP): facial pain resulting from unintentional injury to the trigeminal system from facial trauma, oral surgery, ear, nose and throat (ENT) surgery, root injury from posterior fossa or skull base surgery, stroke, etc.
  • Trigeminal deafferentation pain, (TDP): facial pain in a region of trigeminal numbness resulting from intentional injury to the trigeminal system from neurectomy, gangliolysis, rhizotomy, nucleotomy, tractotomy, or other denervating procedures.
  • Symptomatic trigeminal neuralgia, (STN): pain resulting from multiple sclerosis.
  • Postherpetic neuralgia, (PHN): pain resulting from trigeminal Herpes zoster outbreak. (SHINGLES)
  • Atypical facial pain, (AFP): if facial pain is not diagnosed by any of the categories above, it falls into the AFP category, which is pain that has no known physical cause and is thought to be psychogenic—generated by the brain itself.