Feature Article

Persistent idiopathic facial pain: not just a diagnosis of exclusion

Robert Delcanho



The possible causes of orofacial pain are considerable and form a grey area between medicine and dentistry. An enigmatic condition formerly known as atypical facial pain has been renamed persistent idiopathic facial pain (PIFP) with defined diagnostic criteria. After the common causes of orofacial pain have been ruled out, then a diagnosis of PIFP can be considered.

Key Points

  • Atypical facial pain is a ‘waste basket’ diagnosis that is no longer used. The new term is persistent idiopathic facial pain (PIFP).
  • Defined diagnostic criteria for PIFP have been published but are not yet universally accepted.
  • Patients with PIFP often visit multiple dental and medical practitioners in an attempt to diagnose and treat their pain, and undergo interventions or procedures without success or with exacerbation of the symptoms.
  • PIFP should only be diagnosed after a thorough medical and dental history has been taken, then extra- and intraoral clinical examinations and appropriate imaging tests have ruled out other far more common causes of orofacial pain.
  • Many patients with PIFP are middle to older aged women with comorbid psychological problems, yet no cause–effect relationship has been established.
  • It is likely that PIFP is a neuropathic pain disorder involving abnormal peripheral nerve and central nervous system responses to a minor injury.
  • Multidisciplinary assessment and pain management with pharmacological, nonpharmacological and interventional treatments are recommended.
  • Future research is needed to establish clear diagnostic criteria and treatment strategies.

    Picture credit: © BSIP/Oissonnet/Medical Images
    Model used for illustrative purposes only