Three cases of persistent idiopathic facial pain successfully treated with low doses of tricyclic antidepressants

Abstract

Facial pain as a symptom frequently observed in routine clinical services is caused by headache; oral, ophthalmologic, nasal, and oral abnormalities; facial impairment; and cranial nerve disorders. However, some patients have long-lasting facial pain with no organic changes or nonmeeting criteria of trigeminal neuralgia or migraine. These cases are usually diagnosed as persistent idiopathic facial pain (PIFP). Here we report 3 PIFP cases with intractable pain for 2-20 years that were successfully treated with nerve blocks and 10-25 mg/day tricyclic antidepressants (TCAs). Pain relief was subsequently maintained with low-dose (10 mg/day) TCAs. Although its therapeutic mechanism has not yet been fully clarifi ed, this approach is suggested to be effective for patients with nonretractable facial pain.