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Managing Chronic Facial Pain: A Comprehensive Approach

Dr. Nisha Sharoff

Dr. Nisha Sharoff

DDS, MS, Orofacial Pain Specialist

December 20, 2024
15 min read

Living with chronic facial pain can feel overwhelming—both physically and emotionally. It often impacts not just the face, but quality of life, sleep, relationships, and even mental health. For many people, getting a clear diagnosis and effective treatment takes time, persistence, and the right guidance.

As an orofacial pain specialist, my mission is to provide compassionate, evidence-based care using a comprehensive approach. In this blog, I'll walk you through the various types of chronic facial pain and the wide range of treatment options available—so you feel informed, empowered, and less alone in your journey.

What Is Chronic Facial Pain?

Chronic facial pain refers to persistent pain in the face, jaw, or mouth that lasts longer than 3 months. It can come from a variety of causes, including nerve dysfunction, musculoskeletal issues, trauma, dental conditions, or underlying medical disorders.

Some common types include:

Temporomandibular Disorders (TMD): Pain in the jaw joints and muscles controlling jaw movement.
Trigeminal Neuralgia: Sharp, electric-shock-like pain along the trigeminal nerve.
Atypical Facial Pain: Diffuse, hard-to-localize pain without a clear cause.
Burning Mouth Syndrome: A burning sensation in the mouth, often without visible signs.
Post-Traumatic or Post-Surgical Pain: Pain that persists after dental procedures or facial injuries.
Headache Disorders: Such as migraines or tension-type headaches that manifest in the facial area.

A Multidimensional Treatment Approach

Chronic facial pain is rarely solved with a one-size-fits-all solution. It often involves multiple systems—muscular, neurological, psychological—so a multidimensional treatment plan is key. Here's a look at the available treatment modalities, grouped by category:

Conservative & Behavioral Therapies

Patient Education

Understanding your diagnosis and pain mechanisms is the first step toward healing. Knowledge helps reduce fear and anxiety, which can amplify pain perception.

Physical Therapy

A customized program may include gentle jaw and neck exercises, posture correction, myofascial release, and neuromuscular re-education. Physical therapy can be incredibly effective, especially in cases of TMD or musculoskeletal dysfunction.

Cognitive Behavioral Therapy (CBT)

Pain affects mood, and mood affects pain. CBT helps patients manage stress, anxiety, and depression, all of which can exacerbate chronic facial pain. It teaches coping mechanisms, relaxation techniques, and pain reframing.

Biofeedback & Mindfulness

These techniques help train your body and mind to respond differently to pain signals. They can lower muscle tension and reduce autonomic stress responses.

Pharmacologic Treatments

Analgesics & Anti-Inflammatories

Over the counter or prescription NSAIDs may be used for short-term relief. For long-term management, they're usually combined with other modalities.

Neuropathic Pain Medications

For nerve-related facial pain (like trigeminal neuralgia), options may include anticonvulsants (e.g., carbamazepine, gabapentin), tricyclic antidepressants (e.g., amitriptyline, nortriptyline), and SNRIs (e.g., duloxetine). These medications don't just relieve pain—they help modulate nerve signals.

Muscle Relaxants

These are sometimes prescribed for short-term use in cases involving muscle tension or spasm.

Topical Agents

Creams or patches containing lidocaine, capsaicin, or other numbing agents can provide localized relief.

Minimally Invasive Procedures

Botox Injections

Botulinum toxin is now used for certain types of chronic facial pain, including TMD-related muscle pain, migraine-related facial pain, and some forms of neuralgia. Botox works by relaxing overactive muscles and modulating nerve signaling.

Trigger Point Injections

For patients with myofascial pain (pain originating from muscle trigger points), these injections can provide targeted relief.

Nerve Blocks

These are injections that numb specific nerves, offering temporary or even long-lasting relief. They are both diagnostic and therapeutic tools.

Advanced Neuromodulation & Interventional Therapies

For more stubborn or severe cases:

TENS (Transcutaneous Electrical Nerve Stimulation)

This non-invasive therapy uses mild electrical currents to stimulate nerves and interrupt pain signals.

Peripheral Nerve Stimulation

A more advanced option involving the placement of electrodes near the affected nerve. It's used in severe, treatment-resistant cases.

Radiofrequency Ablation

Involves using heat to 'quiet' overactive pain pathways—often used for certain neuralgias.

Dental & Orthopedic Interventions

Occlusal Splints (Night Guards)

Used for patients with bruxism (teeth grinding) or jaw clenching, especially at night. These reduce strain on the jaw joint and muscles.

Orthodontic Adjustments

Sometimes necessary if misalignment contributes to jaw strain or facial pain.

Surgical Evaluation

In rare cases, surgery may be indicated—for example, if there's structural damage in the jaw joint, a tumor, or compression of a nerve.

Complementary & Lifestyle-Based Therapies

Acupuncture

Many patients find relief from acupuncture, which can reduce muscle tension and stimulate endorphins.

Diet & Nutrition

Avoiding hard, chewy, or trigger foods can make a significant difference in some cases. An anti-inflammatory diet may also help reduce systemic pain levels.

Stress Reduction Techniques

Chronic stress can feed chronic pain. Incorporating yoga, meditation, and regular exercise can support healing and resilience.

Building a Personalized Treatment Plan

No two patients are alike. That's why a thorough evaluation—including medical history, imaging, and sometimes diagnostic testing—is critical. From there, we build a tailored treatment plan, often combining multiple approaches to maximize relief and function.

At my practice, we aim for:

  • • Precise diagnosis
  • • Gentle, effective treatment options
  • • Ongoing education and support
  • • Collaboration with other specialists when needed (neurologists, psychologists, dentists, etc.)

Final Thoughts

Chronic facial pain is not "just in your head"—and it's not something you have to live with forever. With the right care, most people can find significant relief, improved function, and a better quality of life.

If you or a loved one is struggling with persistent facial pain, know that help is available—and healing is possible.

Ready to Find Relief from Chronic Facial Pain?

Don't let chronic pain control your life. Schedule a comprehensive consultation to explore personalized treatment options and start your journey toward healing.

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