OHSU

Diagnostic Questionnaire

In the OHSU Facial Pain Program, we have developed some questions to help you understand your facial pain. These are not a substitute for seeing your doctor if you have facial pain. The answers may help you decide to see your primary care doctor or a facial pain specialist.

Try the Facial Pain Diagnosis tool.

Talking About Facial Pain with Kim Burchiel, M.D.

Kim Burchiel, M.D. is a neurosurgeon (doctor specializing in surgery for nerve and nervous system conditions) and facial pain expert. He answers questions about facial pain from Shirley McCartney, Ph.D. at the OHSU Department of Neurological Surgery.

Shirley McCartney, Ph.D.
Can you tell us what you are trying to accomplish with your system for classifying facial pain?

Kim J. Burchiel, M.D.
Trigeminal neuralgia has been known for over three hundred years. Despite this long record, there has never been a study done that definitely shows how TN behaves over the life of the patient. The goals of my classification system are not pathophysiologic; they are pragmatic, and patient-oriented. My idea is to glean what we can from the history of the patient, and make the best diagnosis possible.

McCartney
How is this system different from other methods of diagnosing facial pain?

Burchiel
Since we are, to a substantial degree, at the mercy of the patient's history, and can usually make the "diagnosis" from the history, my goal is to codify the ways in which we establish the diagnosis by questioning the patient.

McCartney
How did you go about finding the right questions to ask the patients?

Burchiel
I had a feel for the most important questions, and early versions of our questionnaire tested these questions and others. We found that certain questions were confusing or irrelevant, and these were dropped. The 22 that are left all seem to make a difference in establishing the target diagnosis - that being the diagnosis that I would reach after talking to the patient.

McCartney
So what role does the doctor have in the process?

Burchiel
The diagnostic scheme effectively takes the physician out of the process - for better or worse. The patient makes the diagnosis by the answers to the questions.

McCartney
Could you explain how it works?

Burchiel
The "rules" of the scheme define the target diagnosis. The rules are more significant than they appear at first. Trigeminal Neuralgia is considered a continuum from 100 percent episodic pain to 100 percent constant pain. The only additional rule on TN is that there cannot be any history of trauma, trigeminal nerve injury (accidental or therapeutic), multiple sclerosis (MS) or facial shingles. TN is then arbitrarily divided into TN1, which is defined as more than 50 percent episodic pain, and TN2, which is more than 50 percent constant pain. Trigeminal neuropathic pain, or TNP, is considered any chronic facial pain resulting from non-therapeutic, that is, unintentional, trigeminal system injury. This can occur from facial trauma, prior ENT or oral surgery procedures, or other causes. Trigeminal deafferentation pain, or TDP, is considered to be any chronic (long-term) facial pain resulting from therapeutic, that is, intentional, trigeminal system injury. This can occur from rhizotomy, radiosurgery, tractotomy, and other causes. Post-herpetic neuralgia, or PHN, occurs only after an obvious infection with herpes zoster (shingles)in the eye and forehead. A history of multiple sclerosis indicates that the patient may have "Symptomatic TN", or STN.

McCartney
At this point, where do you see this project going?

Burchiel
I see this as several opportunities. First, I see patients making their own diagnosis. This will empower them to seek information about that diagnosis, and to find the right specialists to help them. This will hopefully lead them to earlier, more effective and less complicated therapies. Secondly, I see the advantage that we clinicians can now start talking about facial pain in a consistent manner. It will allow the doctors to begin to compare results in a meaningful way, since we all will be using the same diagnostic scheme. This will allow us to compare our results based on the specific diagnosis of the patient.

McCartney
What do you see as the best way to get this information to patients with TN?

Burchiel
Right now, I think the best means to communicate with patients and other doctors is the Web. We are developing a website that will offer information, references, videos, research updates and an interactive page that will allow patients to effectively make their own diagnosis. This site will grow and improve over time, and we add more information. In the OHSU Facial Pain Program, we have developed some questions to help you understand your facial pain. These are not a substitute for seeing your doctor if you have facial pain. The answers may help you decide to see your primary care doctor or a facial pain specialist. Try our free interactive online Facial Pain Diagnosis tool.