Daijiworld Media Network - Mumbai

Mumbai, Dec 3: A new international Delphi study has shed light on the complexities surrounding Persistent Idiopathic Facial Pain (PIFP), a rare condition marked by chronic facial discomfort without any identifiable cause. The expert panel stressed the importance of thorough dental evaluation and routine dental imaging to rule out tooth-related problems.

However, neurologists caution that relying too heavily on dental pathways may overlook cases where facial pain occurs despite no clear intraoral findings. The study suggests that more defined criteria for when to use advanced neuro-imaging like MRI, and when to seek consultation from headache specialists, would support balanced clinical decision-making.

Before diagnosing PIFP, other causes such as migraine, trigeminal neuralgia, painful trigeminal neuropathy and hemicrania continua must be carefully excluded. Physicians say distinguishing between these disorders can be challenging because migraine itself can sometimes show up as facial pain. A detailed clinical history that checks for sensitivity to light and sound, unusual numbness and one-sided symptoms remains vital to avoid misdiagnosis. Experts believe a step-by-step clinical pathway that combines both dental and neurological perspectives will help improve uniformity in treatment across different specialties.

The study also highlights the need for an integrated care plan that includes patient education, cognitive-behavioural strategies, better sleep routines and regular physical activity. While these therapies match standard chronic pain care, specialists warn against presenting facial pain solely as psychological, as it may leave patients feeling misunderstood or neglected.

Although strong clinical trials are lacking, medications used for migraine and nerve pain — such as tricyclic antidepressants, SNRIs and gabapentinoids — remain options when chosen collaboratively with patients. Combining behavioural support with carefully monitored medication trials helps maintain patient confidence and emotional well-being.

Researchers note that this consensus is an important step toward establishing future guidelines. They say that refining referral protocols, clarifying the need for neuro-imaging and developing practical medication plans will move care forward. A coordinated, compassionate and multidisciplinary approach is believed to offer the best chance of improving outcomes for individuals living with this difficult and often frustrating chronic pain condition.