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23rd Annual Pain Medicine Meeting 2024
November 21-23, 2024 | Caesars Palace, Las Vegas, Nevada
6333
OROFACIAL COMPLEX REGIONAL PAIN SYNDROME: A REVIEW OF CASE REPORTS
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Scientific Abstracts > Chronic Pain
Orofacial Complex Regional Pain Syndrome: A Review of Case Reports
OBJECTIVE
•We present an evidence-based narrative comprised of prior reports of complex regional pain syndrome (CRPS) with face and neck involvement with an additional focus on evaluation and treatment.
METHODS
•A comprehensive search of relevant literature was conducted in the MEDLINE (PubMed) database using the keywords “face”, “facial pain”, “complex regional pain syndrome” and “trigeminal neuralgia”. Case reports of CRPS affecting the orofacial region published between January 1, 2010, and December 31, 2023, were reviewed and analyzed with regard to disease presentation, diagnosis, and management.
RESULTS
•Our literature review identified ten cases of CRPS with face and neck involvement (Table 1).
•Orofacial CRPS typically followed head and neck trauma and dental procedures, with presumed injury to the trigeminal nerve. In most cases, the predominant complaints of burning pain, hyperalgesia, and allodynia in the facial region were accompanied by skin color, temperature, and trophic changes.
•In some patients, ocular manifestations including periorbital edema, ptosis, persistent eye pain, and visual abnormalities were described.
•Conservative management with physiotherapy and desensitization techniques provided favorable outcomes in three patients.
•A series of stellate ganglion blocks were most frequently utilized to treat orofacial CRPS with significant pain relief noted in four patients lasting from three months to two years.
DISCUSSION
•While the authors of these case reports have designated a diagnosis of orofacial CRPS, it should be noted the International Classification of Orofacial Pain published by the International Headache Society does not recognize CRPS with face and neck involvement as an orofacial pain syndrome.1
•Similar to CRPS presentations following injury to an extremity, patients with head and neck involvement report neuropathic pain accompanied by signs and symptoms of autonomic dysfunction.
•Sympathetic hyperactivity has been implicated in the pathogenesis of CRPS, postulated to result from increased expression of sympathetic receptors on nociceptive nerves following tissue damage.2
•The positive response to sympathetic blockade with local anesthetic and sympatholytic agents such as clonidine further suggests a component of sympathetically mediated pain.3,4
•The Budapest Criteria, a widely recognized diagnostic criteria for this condition has not been validated for CRPS affecting the orofacial region.5
•Given the location of orofacial CRPS, a comprehensive diagnostic workup may be required to differentiate between dental, musculoskeletal, neurological, vascular, auditory, and ocular pathology.
•A comprehensive multidisciplinary treatment approach should be initiated focusing on improving functional outcomes and inclusive of frequent patient education and reassurance.