Challenges in the Differential Diagnosis of Orofacial Pain: Differentiating Neuropathic and Myofascial Components

Resumo

Introduction: Orofacial pain poses a complex diagnostic challenge, particularly in distinguishing between neuropathic pain (NP) and myofascial pain (MP) associated with temporomandibular disorders (TMD). Although they may coexist, these conditions require divergent therapeutic approaches. Objective: To analyze, through an integrative literature review, the main clinical and diagnostic criteria used to differentiate neuropathic pain from myofascial pain in the orofacial region. Methodology: An integrative review was conducted in PubMed/MEDLINE, Scopus, and Web of Science databases. Articles published between 2020 and 2025 in English and Portuguese were included, using descriptors related to facial pain, neuralgia, and myofascial pain syndromes. Results: The literature indicates that NP presents a specific sensory signature characterized by burning, electric shock, and paresthesia, often accompanied by somatosensory changes (allodynia, hyperalgesia). In contrast, MP manifests as deep, oppressive pain strictly related to mandibular function and the presence of trigger points and taut bands. Therapeutic failure to conventional TMD treatments is a significant indicator of an underlying neuropathic component. Conclusion: Clinical differentiation between NP and MP is feasible and fundamental. The use of validated protocols, such as DC/TMD and ICOP, combined with a systematized physical examination distinguishing function-provoked pain (myofascial) from spontaneous or sensory pain (neuropathic), constitutes the gold standard strategy to avoid irreversible and ineffective interventions.