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Pain paper 2b: classification of orofacial pain and an update on assessment and diagnosis Obi Egbuniwe Tara Renton Dental Update 2024 42:4, 707-709.
Authors
ObiEgbuniwe
BDS, MSc, PhD
Honorary Clinical Researcher, Department of Oral Surgery, King's College London Dental Institute, King's College Hospital London, Bessemer Road, London SE5 9RS, UK
Professor of Oral Surgery, King's College London; Honorary Consultant in Oral Surgery, King's College Hospital NHS Foundation Trust and Guy's and St Thomas' NHS Foundation Trust, London
The classification of chronic orofacial pain remains a contentious area. However, more recently, with the clarification of pain mechanisms and improved understanding of the underlying neurophysiology and modulation factors, there is more clarity of the possible division of pain conditions. Interestingly, the pathophysiology provides a basis for classification that has more clinical relevance. The principles of assessing and managing patients with pain have modified significantly, in line with recent improved understanding of the affective and emotional components in pain behaviour and suffering.
Clinical Relevance: This paper aims to provide the dental and medical teams with a review of the classification of trigeminal pain with an overview of how to assess and diagnose patients with trigeminal pain.
Article
There have been several attempts to classify chronic orofacial pain (OFP) conditions by pain associations. The most used main categories have either been topographical (odontogenic versus non-odontogenic) and/or chronological (chronic versus acute). Several associations with interest in pain have published classifications: The International Association for the Study of Pain;1 International Headache Society (International Classification of Headache Disorders 2nd edn;2 The American Academy of Orofacial Pain;3 and the Research Diagnostic Criteria for Temporomandibular Disorders.4 As one would expect, critique and suggestions for modification for most of these systems has been published.5
The IASP classification1 categorized orofacial pain (OFP) into ‘Relatively Localized Syndromes of the Head and Neck’ composed of five axes. The IASP system does not, however, fully address the psychosocial aspects of pain, which are required in order to provide a more comprehensive view of the disorder. There is a suggested modification of the classification, which may be applicable to the IASP (the Multiaxial Assessment of Pain [MAP]), as it integrates physical, psychosocial, and behavioural data.
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