Perceptions of persistent idiopathic facial pain: a comprehensive study of adults in Ha'il city, Saudi Arabia

Background: Persistent idiopathic facial pain (PIFP) is a complex condition characterized by chronic, unexplained facial pain that significantly impacts patients’ quality of life and remains poorly understood by the general public. This research aimed to assess the knowledge and understanding of PIFP among the general population of Ha’il, Saudi Arabia. Methods: This cross-sectional study examined Ha’il residents’ attitudes and levels of knowledge regarding PIFP and investigated the associated factors. Anonymised surveys were distributed to 350 respondents between November 2023 and March 2024. The original survey draft was based on a combination of previously published research, the Facial Pain Association, and previously validated questionnaires addressing similar objectives. A standardised survey scheme was designed, pre-coded and validated. The refined survey instrument was then transformed into an online questionnaire using Google Survey© 2023 and distributed. Results: In total, 254 respondents filled out the survey. The chi-square test was utilised to assess knowledge and attitudes in relation to participants’ sociodemographic characteristics. Spearman’s rank correlation coefficient (p < 0.05), odds ratios and confidence intervals were calculated to assess the relationship between attitudes and knowledge. Binary logistic regression analysis was performed to identify predictors of high knowledge levels and positive attitudes. The participants showed moderate knowledge of PIFP, with 51.24% correct responses. Notably, 96.90% identified dental issues, infections and nerve abnormalities as key factors. Gender influenced perceptions, with 30.9% of women and 45.9% of men downplaying PIFP’s significance, while age, education and occupation had minimal impact (p > 0.05). Conclusions: This study emphasises the critical need for targeted educational programs to address misconceptions and information gaps around PIFP. The information gained highlights the need for an advanced approach to health education and communication that is tailored to the unique cultural and demographic characteristics of Ha’il, Saudi Arabia.

Idiopathic facial pain; Perception; Pharmacotherapy; Behavioural therapy; Treatment; Saudi Arabia

[1] Gerwin R. Chronic facial pain: trigeminal neuralgia, persistent idiopathic facial pain, and myofascial pain syndrome—an evidence-based narrative review and etiological hypothesis. International Journal of Environmental Research and Public Health. 2020; 17: 1–20.

[2] Benoliel R, Gaul C. Persistent idiopathic facial pain. Cephalalgia. 2017; 37: 680–691.

[3] Zegeler C, Brauns G, May A. Characteristics and natural disease history of persistent idiopathic facial pain, trigeminal neuralgia, and neuropathic facial pain. Headache. 2021; 61: 1441–1451.

[4] Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38: 1–211.

[5] Almutairi KM. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal. 2015; 36: 425.

[6] Mueller D, Obermann M, Yoon MS, Poitz F, Hansen N, Slomke MA, et al. Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study. Cephalalgia. 2011; 31: 1542–1548.

[7] Zeytin Demiral G, Türk Börü Ü, Bölük C, Acar H, İncebacak F. Prevalence of trigeminal neuralgia and persistent idiopathic facial pain in Afyonkarahisar, Türkiye. Neuroepidemiology. 2024; 58: 394–400.

[8] Lambru G, Zakrzewska J, Matharu M. Trigeminal neuralgia: a practical guide. Practical Neurology. 2021; 21: 392–402.

[9] Kotlyar A. Treatment of facial pain with I Ching balance acupuncture. Medical Acupuncture. 2017; 29: 405–410.

[10] Evans RW, Agostoni E. Persistent idiopathic facial pain. Headache. 2006; 46: 1298–1300.

[11] Florkow MC, Willemsen K, Mascarenhas VV, Oei EH, van Stralen M, Seevinck PR. Magnetic resonance imaging versus computed tomography for three‐dimensional bone imaging of musculoskeletal pathologies: a review. Journal of Magnetic Resonance Imaging. 2022; 56: 11–34.

[12] Staub BP, Casini GP, Monaco EA III, Sekula RF III, Emerick TD. Near-resolution of persistent idiopathic facial pain with low-dose lumbar intrathecal ziconotide: a case report. Journal of Pain Research. 2019; 12: 945–949.

[13] Xiao X, Jiang L, Liu L, Chai G, Luo F. Challenges of misdiagnosis and suboptimal treatment of persistent idiopathic facial pain and atypical odontalgia: a retrospective multi-centric cross-sectional investigation. Journal of Pain Research. 2020; 13: 2853–2860.

[14] Weiss AL, Ehrhardt KP, Tolba R. Atypical facial pain: a comprehensive, evidence-based review. Current Pain and Headache Reports. 2017; 21: 1–5.

[15] Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. Journal of Headache and Pain. 2013; 14: 1–6.

[16] McMahon JT, Tora MS, Bentley JN, Texakalidis P, Campbell MA, Keifer Jr OP, et al. Percutaneous trigeminal nerve stimulation for persistent idiopathic facial pain: a case series. World Neurosurg. 2019; 126: e1379–e1386.

[17] Sunil DC, Ramnani P, Thakur D, Pandit M. Botulinum toxin in the treatment of muscle-specific oro-facial pain: a literature review. Journal of Maxillofacial & Oral Surgery. 2015; 14: 171–175.

[18] Antony AB, Mazzola AJ, Dhaliwal GS, Hunter CW. Neurostimulation for the treatment of chronic head and facial pain: a literature review. Pain Physician. 2019; 22: 447–477.

[19] Rahimpour S, Lad SP. Surgical options for atypical facial pain syndromes. Neurosurgery Clinics of North America. 2016; 27: 365–370.

[20] Schweiger V, Nocini R, De Santis D, Procacci P, Zanette G, Secchettin E, et al. Persistent idiopathic facial pain (PIFP) in patients referred to a multidisciplinary centre in Italy: a retrospective observational study. Journal of Clinical Medicine. 2022; 11: 3821.

[21] Facial Pain Association. You’re not alone. 1990. Available at: https://www.facepain.org (Accessed: 17 November 2024).

[22] Maarbjerg S, Wolfram F, Heinskou TB, Rochat P, Gozalov A, Brennum J, et al. Persistent idiopathic facial pain: a prospective systematic study of clinical characteristics and neuroanatomical findings at 3.0 Tesla MRI. Cephalalgia. 2017; 37: 1231–1240.

[23] Mandorah AO, Alshahrani GM, Alkhalifah TS, Alrashidi AR, Almuzaini SS, Alshdokhy EA, et al. Prevalence, knowledge, and awareness of atypical facial pain among adults in Saudi population. Journal of Electrical Systems. 2024; 20: 394–401.

[24] British and Irish Society for Oral Medicine (BISOM). Persistent idiopathic facial pain (PIFP) patient information leaflet. 2020. Available at: https://bisom.org.uk/wp-content/uploads/2020/08/PIFP-PIL.pdf (Accessed: 17 November 2024).

[25] Brennan N, Barnes R, Calnan M, Corrigan O, Dieppe P, Entwistle V. Trust in the health-care provider–patient relationship: a systematic mapping review of the evidence base. International Journal for Quality in Health Care. 2013; 25: 682–688.

[26] Euasobhon P, Atisook R, Bumrungchatudom K, Zinboonyahgoon N, Saisavoey N, Jensen MP. Reliability and responsivity of pain intensity scales in individuals with chronic pain. Pain. 2022; 163: e1184–e1191.