Treatment of chronic facial pain.

Facial pain occurs because of damage to the fifth cranial nerve anywhere along its course from its terminal subcutaneous craniofacial branches to the brainstem. Although topical agents may be effective in relieving pain caused by subcutaneous branch damage, systemic oral agents are usually needed to alter or correct deeper trigeminal nociceptive pain caused by damage to the trigeminal nerve further along its course. Antidepressive agents with anti-nociceptive properties, anticonvulsants, and anti-inflammatory agents are most commonly used. Newer agents are beginning to replace the commonly used first-line medications. Combination therapy is popular because it maximizes the effect of each drug while reducing the side effects seen in higher-dose monotherapy. Treatment of secondary clinical depression is very important in the management of patients with facial pain, explaining the beneficial dual role of antidepressants in this condition. Alternative and holistic approaches are also popular, but most are not confirmed by controlled studies at the present time.