It is known that many patients with chronic pain at various parts of their bodies do not show any abnormal physical signs or manifest any severe organic illness. Atypical facial pain is a particularly frequent and difficult example to be treated, manifests no organic signs but causes great suffering. Forty seven patients, aged 18 to 60, suffering pain for more than one year, were enrolled in medical intractable atypical facial pain, defined according to the ICD-10, International Classification of Disease and Health related Problems Tenth Revision 1992, WHO 1992-G50.1. Additional inclusion criteria were lack of response to drug therapy following adequate administration - fixed as at least 12 weeks - or at least four antidepressants one of which had to be amitryptyline and another monoaminooxidase inhibitor, with augmentation for a period of at least 1 month, with antipsychotic phenothiazine and normal findings on magnetic resonance imaging. All patients studied were severely and unbearably humiliated in some realm of their professional or private lives. The onset of pain in ten patients took place after the episode of humiliation. All patients were treated until September 2011. The results achieved suggested that: atypical facial pain is a psychiatric derangement resulting from adverse life events; all patients underwent serious humiliation; association of tryciclic antidepressant amitriptyline with the typical antipsychotic chlorpromazine and psychotherapy has proven to be the best treatment. The best results were obtained in patients who experienced the onset of depressive or anxiety symptoms after initiation of atypical facial pain and underwent a small number of oral surgery and no neuroablative surgery.
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