Classification: The key to understanding facial pain

Abstract

It is indisputable that the global scientific advances in headache research, be it bench or bedside, have benefited enormously from the operational diagnostic criteria published in 1988. Today, this classification system is indispensable. The reason for this success is a low inter-rater variability. In general, orofacial pain conditions are less well characterised – with the noticeable exemption of temporomandibular disorder pain. Tremendous work has been put into changing this, and significant progress has been achieved – in particular, in terms of the clinical implications and overriding conceptual models for oro-facial pain. Scientific classifications have only one goal: To provide a scientific agreement about the main features of an object of research and a scientific consensus regarding the name. The main significance is not the fact that a good classification offers a detailed and accurate image of the reality. If we want to overcome the obstacles of different competing classification systems, we need to overcome specialisation borders. The key to success is to understand that such a definition does not mirror all possible clinical facets of a given pain condition but is simply a convention – that is, a consensus on a word used for a pain condition. Simply speaking, a classification creates a common language to be used by more than one profession. It will be crucial to define any given pain condition as precisely and rigid as possible, in order to ensure a homogenous population. Only this ensures a low inter-rater variability, which consequently allows combining and comparing research on a population across different professional settings. This is not easy for chronic facial pain without verifiable morphological cause or structural lesions, as these syndromes are often rather featureless. The new IASP classification of chronic pain is a big step forward to a better characterisation of such conditions, and will trigger future work on a new and operationalised classification of oro-facial pain.