Chronic orofacial pain: a clinical challenge.

Most orofacial pain originates in the oral cavity and the surrounding structures. However, advances in the understanding of pain neurophysiology have shown that convergent afferent nociceptive transmissions from non-trigeminal, extraoral sources can enter the trigeminal system. This may confuse the diagnosis by presenting as (or contributing to) dental, sinus, temporomandibular and other head and neck pains. Incorrect diagnoses may lead to inappropriate and/or invasive procedures, creating further problems. Professor Richard Kroening (former Director of the UCLA Pain Management Center) repeatedly emphasised the maxim that "without correct diagnosis, there can be no prognosis". My own areas of special interest have included acute pain management (anaesthesia and conscious sedation) and chronic orofacial pain. I have seen many dental patients who have been referred to multidisciplinary pain management clinics, often after years of failed treatment attempts. More recent experience as a member of a hospital team evaluating long term ACC patients with many types of persistent pain problems again confirms the premise that accurate diagnosis is critical if management is to be successful.