Persistent idiopathic facial pain (PIFP) - what to do

Posted by andrewmuscat @andrewmuscat, Dec 21, 2021

I have been suffering from PIFP since 2020, but it took a real turn for the worse in Jan 2021 after it was misdiagnosed and i underwent a root canal treatment. I feel a dull toothache on the left side of my face which recently expanded to the right side on an intermittent basis. My head feels 'bruised'.

I had two MRIs – a standard MRI of the brain and a soft tissue MRI of the head and neck. they showed nothing wrong.

I was first prescribed amitryptaline which did not help. I am now taking pregablin, which had a moderate effect for 3 months, but is not helping now. I also had a botox procedure in my gums, but it did not work.

I then went to a holistic clinic, trying to learn how to control the pain. Unfortunately this did not help either.

I was wondering if anyone has had similar symptoms and/or can give me any advice on what to do next. Living in near constant pain is completely debilitating and has complely ruined my life. I have three children aged 6 and under and it kills me that i am no longer the father i was a year ago.

Interested in more discussions like this? Go to the Chronic Pain group.

Hello Andrew and welcome to Connect. The source of pain can get pretty confusing sometimes, and it can also have multiple causes and overlapping of similar symptoms. It sounds like your dentist got this wrong. I do understand why that could have happened because of pain that isn't related to the teeth, but it feels like it is. the nerves that run into the jaw are going through some pretty small spaces between the base of the ear and the lower jaw. If any of that is misaligned, it pinches those nerves and you get pain in the teeth and jaw. It can even seemingly travel among the teeth. I have experienced that, and I have had TMJ misalignment issues of my lower jaw. With the headaches you described, my thoughts would be that you may want to see a physical therapist who could assess the alignment of your head, neck and jaw.

I have had all these issues myself as well as real dental problems contributing to all of it over time. I had a whiplash years ago and then developed spine problems and thoracic outlet syndrome which causes one side of my neck to be tighter than the other. I had a bulging C5/C6 disc which eventually ruptured and required surgery 5 years ago. For a long time, one side of my jaw was too tight and I was wearing out fillings on that side of my mouth. Physical therapy helped get everything back in alignment and since surgery, the muscle spasms in my neck have calmed down, but it is still tight from years of issues. I had a lot of dental work because I had broken my front teeth as a kid which led to root canals in those teeth because of the trauma, and 50 years later, the first of them failed and I didn't recognize the problem until it has eaten the bone around the tooth away. I had felt the pain, but I thought it was sinus trouble because that also can cause pain just like a toothache. This tooth was part of a bridge of the front 4 teeth, so it didn't get loose. It would have fallen out if it was not part of a bridge. So when I recognized the issue, it was pretty advanced, and I saw an oral surgeon who saved the tooth by cleaning out the infection and replacing bone in the jaw. A couple years later, the 2nd of the 4 root canals failed, and I made the decision to remove the teeth and replace them with ceramic dental implants an a new bridge. Now if those teeth hurt, I know it really is sinus related or alignment related.

My physical therapist also does myofascial release which helps loosen the overly tight muscles and fascia that are pulling everything out of alignment. If you can find a PT with those skills, that would be my suggestion.

Here is our discussion on myofascial release https://connect.mayoclinic.org/discussion/myofascial-release-therapy-mfr-for-treating-compression-and-pain/

and there is a provider search on the MFR website at http://mfrtherapists.com/

MFR has helped me a lot and I recommend it often. Does MFR seem like something you would want to try?

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