Some facial pain presentations are diagnostically challenging, and the evolution of symptoms over time may either clarify, or rule out, the diagnosis initially given. Extant classification systems may also hinder diagnosis or result in inaccurate labeling. It has been

found that the number of patients whose symptoms could not be classified as a specific diagnosis was larger in ICHD-II than in ICHD-I, with particular difficulty experienced in patients with persistent idiopathic facial pain.[109] In a study examining the usefulness of the ICHD-II classification criteria, only 56% of patients were successfully diagnosed with orofacial pain using ICHD-II.[2] Applying American Academy of Orofacial Pain (AAOP)/Research Diagnostic Criteria for

Temporomandibular Disorders PD 332991 (RDCTMD) criteria, a further 37% were diagnosed with masticatory myofascial pain (MMP), and further published criteria enabled the remaining patients to be allocated to other predefined diagnoses. The authors concluded that while MMP is clearly defined by AAOP and the RDCTMD, expansion of ICHD-II was needed so as to integrate more orofacial pain syndromes. It may be better to check details give no diagnosis rather than the wrong diagnosis, as revising a diagnosis that has previously been presented to the patient as definitive can be damaging to the therapeutic relationship and the patient’s confidence in the clinician. The use of a grading system such 上海皓元医药股份有限公司 as “definite,” “probable,” or “possible” has been suggested for use when diagnosing neuropathic pain.[110] This classification could be extended to other orofacial pain diagnoses as a means of managing the uncertainty in providing diagnoses

for conditions that have varied clinical presentations. Ontological approaches to the diagnosis and classification of facial pain syndromes aim to reduce the problems associated with “labeling” and focus on the use of purely descriptive terms with no inferences made regarding mechanism or etiology.[27] Labeling” or compartmentalizing patients into diagnostic categories also ignores the multifaceted nature of chronic pain syndromes, particularly orofacial pain. The patient is not the diagnosis – rather the pain condition has occurred in a patient who exists within a milieu of social, cultural, psychological, and cognitive influences. Patients’ beliefs about their condition will also affect their disability and outcome,[111] as the quote in Figure 3 — illustrates. Recognizing the significance of these contributory factors to the overall presentation is essential for effective therapeutic dialogue as well as good management of pain. This concept has been further explored in a recent series of qualitative studies examining patients’ experience and perception of orofacial pain.[26, 102, 105] As with any other chronic pain psychological factors will increase pain disability.