Headache Medicine 2020, 11(2):28-29 ISSN 2178-7468, e-ISSN 2763-6178

ASAA

DOI: 10.48208/HeadacheMed.2020.8

Headache Medicine

Editorial

The new pathways of orofacial pain: the just released

“International Classication of Orofacial Pain" - First edition

(ICOP)

Paulo Cesar Rodrigues Conti

Juliana Stuginski Barbosa

Leonardo R Bonjardim

Daniela Aparecida

de Godoi Gonçalves

Faculdade de Odontologia de Bauru, Universidade de São Paulo, USP, São Paulo, Brazil.

Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista, UNESP, Araraquara, São Paulo, Brazil.

After the extraction of a third molar tooth, and after the normal healing period, Mrs. Maria started

to experience constant, burning, and sometimes electric shock-like pain at the surgery site. She

was treated by several professionals that offered different treatment options, including surgical

procedures, the use of various painkillers, as well as psychological support. However, none of the

approaches was able to ease her suffering. Only after many tentative during several months she

got an accurate diagnosis and adequate therapy. This trajectory brought her anxiety, suffering,

and loss of quality of life. Unfortunately, cases like Mrs. Maria’s are not rare in Dentistry, and

perhaps symbolize the same scenario of headache patients 30 years ago, before the establishment

of validated diagnostic criteria.

Chronic Orofacial Pain (OFP) comprises a diverse group of extraoral and intraoral painful manifes-

tations that may include dental pain, muscle, and articular (temporomandibular joint - TMJ) pain, as

well as posttraumatic neuralgias, which are difcult to diagnose and control. Beyond the potential

negative impact on patients’ quality of life, these conditions are also frequently associated with other

comorbidities, such as primary headache, bromyalgia, neck pain, and others.

2,3,4

As illustrated in the case above mentioned, dentists daily deal with critical challenges and dif-

culties in the recognition and diagnosis of such conditions. Such problems are often shared with

other health professionals, such as physicians, psychologists and physical therapists, who may

be involved in the care of patients with such conditions. These facts perhaps are related to the

complexity of the Trigeminal System, which is composed of three nerve branches, sharing neural

pathways with many other cranial and cervical nerves.

Another critical problem is the absence

of a worldwide accepted and comprehensive classication able to reect in appropriate and

evidence-based management strategies. An unrecognized and unclassied condition cannot be

treated!

An inherent characteristic of human beings is the tendency to group objects or creatures with

similar characteristics. Primitive man, for example, already divided living beings into two groups:

edible and inedible. In other words, classifying and differentiating is part of the evolution of the

human race.

Some classication systems consider the OFP conditions, such as the “International Classication

of Headaches Disorders” (ICHD)

, and the “Diagnostic Criteria for Temporomandibular Disorders”

(DC/DTM).

However, none of them encompass, in an organized and hierarchical manner, all

possible painful manifestations of the face and oral cavity.

Thus, a joint initiative was launched with the participation of several entities, such as the Special

Interest Group in Orofacial Pain and Headache (SIG-OFHP) of the IASP (International Association

for the Study of Pain), the International Network for Orofacial Pain & Related disorders Methodology

(INfORM) of the IADR (International Association for Dental Research), the American Academy

of Orofacial Pain (AAOP) and the International Headache Society (IHS). Accordingly, several

professionals, including dentists, neurologists, and psychologists, worked together during a few

years to propose a new classication system that would be helpful in the practice of all health

professionals. Thereby, the “International Classication of Orofacial Pain” -version 1.0 Beta, has

emerged.

Daniela Aparecida de Godoi

Gonçalves

daniela.g.goncalves@unesp.br

Edited by

Mario Fernando Prieto Peres

ASAA

Conti PCR, Barbosa JS, Bonjardim LR, Gonçalves DAG.

The new pathways of orofacial pain: the just released “International Classification of Orofacial Pain - First edition” (icop)

This document represents a signicant improvement for all

professionals involved in the diagnosis and treatment of OFP

and associated morbidities. It aims to increase the integration

among all these specialists in research and clinical settings,

hospitals, and other health services. It also must be incorpo-

rated into ICD-11, representing the recognition of chronic

orofacial pain as a public health problem to be considered

and controlled.

ICOP has a format already established by neurology through

ICHD and embraces the pain from dental and associated

structures, which are the most prevalent types of OFP and

are not considered in the other classication systems. It also

includes the Temporomandibular Disorders (TMD), based on

the well-known DC/TMD, besides the disorders involving inju-

ries of the cranial nerves, facial manifestations similar to the

primary headaches, as well as facial and oral idiopathic pain.

It is well known that some primary headaches may include

facial manifestations during the pain phase. However, some

of them may manifest exclusively in the face, and sometimes,

in the teeth.

Although rare, such conditions represent a major

challenge for all of us. They are also listed in the new ICOP,

which may improve our research opportunities, understanding

leading to a more scientic clinical practice.

As aforementioned, there are many similarities, interests, and

intersections between Dentistry, Neurology, Psychology, and

other areas regarding the recognition and integrated treat-

ment of patients with OFP and chronic headaches. The kickoff

for the ICOP translation into Portuguese has already been

given, and we hope to make it available soon. Thus, we invite

everyone to use, interact, and discuss these new pathways

of the OFP. Our patients who has endlessly and desperately

looking for proper diagnosis and treatments to alleviate their

suering will be the most beneted and thankful. And perhaps,

cases like Mrs. Maria’s may become increasingly rare...

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