Intractable Facial Pain Management: from Conventional Management to Neuromodulation

Facial pain encompasses a heterogeneous group of disorders in the trigeminal system, spanning temporomandibular joint disorder, primary headache disorders, peripheral nerve injury, ganglionopathy, brainstem dysfunction, and centralized pain states, necessitating mechanism-informed treatment strategies rather than uniform therapeutic approaches. The trigeminal system is also a target for emerging targeted biological approaches to pain, including gene therapy and ion channel modulation. The current facial pain management includes medication, injection procedures, microvascular decompression, rhizotomy, and radiosurgery. However, many patients are refractory due to the complexity of pathomechanisms. Intractable facial pain can significantly impact individuals and society, leading to significant disabilities and various burdens. Support from multidisciplinary teams is beneficial in addressing the complex nature of intractable facial pain and its physical and psychological etiologies. A comprehensive treatment plan often requires a multidisciplinary team to provide holistic care tailored to the individual's needs. Beyond the traditional surgical facial pain treatment, neuromodulation offers a uniquely adaptable framework for aligning diagnosis with intervention, ranging from peripheral stimulation for trigeminal neuropathies and focal craniofacial pain syndromes to central neuromodulation targeting thalamic, cortical, and network-level dysfunction in patients with centralized or mixed pain phenotypes. Advances in phenotyping, neuroimaging, and electrophysiology increasingly allow clinicians to distinguish peripheral versus central drivers of pain and to select among an expanding set of neuromodulatory tools accordingly. Looking forward, integration of physiological biomarkers, adaptive stimulation paradigms, and closed-loop control systems holds promise for personalized facial pain therapies that dynamically respond to patient-specific neural states, moving the field beyond static, one-size-fits-all neuromodulation toward precision, mechanism-based care. The scope of the topic spans different specialties, including neurology, neurosurgery, oromaxillary facial pain specialists, anesthesia pain experts, and pain psychology, to discuss the advantages of multidisciplinary facial pain management and to explore emerging approaches to facial pain management. Neuromodulation is a primary focus as a future trend for the management of intractable facial pain, and other advanced treatment options will also be included. Topic editors: Hsinlin Thomas Cheng, David P Darrow, Nicholas Boulis Source: https://www.frontiersin.org/research-topics/79148/intractable-facial-pain-management-from-conventional-management-to-neuromodulation