A new classification for facial pain
- 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
- 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,
- 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.
- Atypical facial pain, (AFP): pain predominantly
having a psychological rather than a physiological origin.
Burchiel KJ. Neurosurgery 2003 Nov;53(5):1164-7
A patient-oriented classification scheme for facial pains commonly
encountered in neurosurgical practice is proposed.
This classification is driven principally by the patient's history.
The scheme incorporates descriptions for so-called "atypical"
trigeminal neuralgias and facial pains but minimizes the pejorative,
accepting that the physiology of neuropathic pains could reasonably
encompass a variety of pain sensations, both episodic and constant.
Seven diagnostic labels result: trigeminal neuralgia Types
1 and 2 refer to patients with the spontaneous onset
of facial pain and either predominant episodic or constant pain,
Trigeminal neuropathic pain results from unintentional
injury to the trigeminal nerve from trauma or surgery, whereas
trigeminal deafferentation pain results from
injury to the nerve by peripheral nerve ablation, gangliolysis,
or rhizotomy in an intentional attempt to treat either trigeminal
neuralgia or other facial pain.
Postherpetic neuralgia follows a cutaneous herpes
zoster outbreak (shingles) in the trigeminal distribution, and
symptomatic trigeminal neuralgia results from
The final category, atypical facial pain, is
synonymous with facial pain secondary to a somatoform pain disorder.
Atypical facial pain can be suspected but not diagnosed by history
and can be diagnosed only with detailed and objective psychological
This diagnostic classification would allow more rigorous and objective
natural history and outcome studies of facial pain in the future.