Orofacial pain affects the quality of life of those who suffer from it and often leads to sleep disturbances and a significant level of disability . It is estimated that there are around 25% of people in the world who suffer from chronic orofacial pain. In many cases, these are pathologies of complex aetiology whose approach requires the intervention of a multidisciplinary team in which the physiotherapist plays a key role.
What is orofacial pain and what are its symptoms?
The symptoms are mainly concentrated in the cervico-cranio-mandibular area . The painful sensation can be accompanied by other signs, such as: disturbed rest, lack of memory, decreased concentration, disproportionate pain experience, diffuse and changing distribution of pain and, on many occasions, a lack of correlation between the physical examination and reported symptoms.
Orofacial pain has a complex etiology and cannot be exclusively attributed to a painful impulse that reaches the brain due to lesions in the orofacial area . Due to its complexity, the International Association for the Study of Pain (IASPT) has created an interest group dedicated exclusively to the study of orofacial pain.
In Spain , the Spanish Society of Craniomandibular Dysfunction and Orofacial Pain (SEDCYDO) was created, with the intention of bringing together all health professionals who could help those who suffer from chronic orofacial pain under the same umbrella.
The main types of orofacial pain
Although there are different types of orofacial pain, work is being done at a transdisciplinary level to achieve an understanding between different health professionals and reach a functional consensus. One of the most important is the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), where clinical reasoning algorithms have been developed based on 2 very different axes:
- Axis I: the instructions for a correct physical examination are specified
- Axis II: the instructions that must be taken into account in relation to psychological variables, which are as unknown as they are important for good pain management, are specified.
To talk about a classification of pain, we must focus on the international research group International Classification of Orofacial Pain (ICOP). Its classification of pain is the one normally used by the Physiotherapist specialized in cervical-cranio-mandibular disorders.
Treatment of orofacial pain
Treatment of orofacial pain will depend on its cause . The fact that the etiology can be treated by different health disciplines requires teamwork that can range from a neurologist to a dentist and specialized physiotherapists. Without a good diagnosis, it is difficult to make an adequate approach, so it is always recommended to go to a specialist who works as a team and is part of a transdisciplinary network.
The physiotherapist specialized in cervical-cranio-mandibular dysfunctions is one of the pillars of orofacial pain treatment. Physiotherapy related to orofacial pain requires a high degree of specialization due to the complexity of the cases that usually fall on their hands. Neuroscience, neurophysiology and extensive knowledge about pain and the biopsychosocial sphere are his best therapeutic tools.
Physiotherapy that treats cervical-cranio-mandibular dysfunctions focuses on the patient at a global level and not only on a structure such as the temporomandibular joint . For treatment, highly specialized tools based on evidence and clinical experience must be used, such as manual therapy, neuroscience, pain education; or, physical tools such as transcutaneous electrical nerve stimulation, to name some of the most important and with more scientific evidence.